Treatment of Mild to Moderate Sinusitis
Stephen R. Smith, MD, MPH ; Lynda G. Montgomery, MD, MEd ; John W. Williams Jr, MD, MHS
Arch Intern Med. 2012;172(6):510-513. doi:10.1001/archinternmed.2012.253
Background
The National Physicians Alliance (NPA)–initiated a project titled "Promoting Good Stewardship in Clinical Practice" to develop a list of the "Top 5" activities in primary care, where changes in practice could lead simultaneously to higher quality care and better use of finite clinical resources. The treatment of acute mild to moderate sinusitis was selected for the "Top 5" list because it is a common clinical problem. Evidence supports avoiding antibiotics early in the course of the illness, and doing so could markedly reduce costs.
Methods
We reviewed the results of meta-analyses of randomized controlled trials published in the past 10 years comparing antibiotic treatment with placebo and summarized the evidence regarding the benefits, harms, and costs of antibiotic treatment of acute mild to moderate sinusitis.
Results
Sinusitis is one of the most common diagnoses in primary care, accounting for 20 million visits annually in the United States and 15% to 21% of annual antibiotic prescriptions. In randomized controlled trials, cure or improvement 7 to 15 days after beginning treatment was statistically significantly more common among patients assigned to antibiotics compared with placebo, but the differences were small, ranging from a 7% to 14% higher rate of improvement with antibiotics. The rate of complications and recurrence did not differ between those treated with antibiotics and placebo. Adverse effects, primarily diarrhea, were 80% more common in the antibiotic compared with the placebo groups. In addition to adverse effects, overuse of antibiotics can also harm population health by increasing rates of antibiotic resistance
Conclusions
Antibiotics should not be prescribed for mild to moderate sinusitis within the first week of the illness. Avoiding antibiotics for acute sinusitis could reduce antibiotic adverse effects, antibiotic resistance, and the cost of health care.
Mi comentario:
en los útimos tiempos hemos tenido una serie de revisiones acerca del adecuado tratamiento de la sinusitis y en una de las últimas revisiones Cochrane (1) se hace mención del uso de esteroides nasales como primera línea de tratamiento o junto a los antibióticos, lo que mejora la resolución del cuadro y la mejoría de los pacientes, por lo que creo que este artículo es muy valioso ya que nos orienta mejor al tratamiento de esta patología tan frecuente.
Bibliografía:
1.- Anca Zalmanovici Trestioreanu, John Yaphe. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews, August 2011
Arch Intern Med. 2012;172(6):510-513. doi:10.1001/archinternmed.2012.253
Background
The National Physicians Alliance (NPA)–initiated a project titled "Promoting Good Stewardship in Clinical Practice" to develop a list of the "Top 5" activities in primary care, where changes in practice could lead simultaneously to higher quality care and better use of finite clinical resources. The treatment of acute mild to moderate sinusitis was selected for the "Top 5" list because it is a common clinical problem. Evidence supports avoiding antibiotics early in the course of the illness, and doing so could markedly reduce costs.
Methods
We reviewed the results of meta-analyses of randomized controlled trials published in the past 10 years comparing antibiotic treatment with placebo and summarized the evidence regarding the benefits, harms, and costs of antibiotic treatment of acute mild to moderate sinusitis.
Results
Sinusitis is one of the most common diagnoses in primary care, accounting for 20 million visits annually in the United States and 15% to 21% of annual antibiotic prescriptions. In randomized controlled trials, cure or improvement 7 to 15 days after beginning treatment was statistically significantly more common among patients assigned to antibiotics compared with placebo, but the differences were small, ranging from a 7% to 14% higher rate of improvement with antibiotics. The rate of complications and recurrence did not differ between those treated with antibiotics and placebo. Adverse effects, primarily diarrhea, were 80% more common in the antibiotic compared with the placebo groups. In addition to adverse effects, overuse of antibiotics can also harm population health by increasing rates of antibiotic resistance
Conclusions
Antibiotics should not be prescribed for mild to moderate sinusitis within the first week of the illness. Avoiding antibiotics for acute sinusitis could reduce antibiotic adverse effects, antibiotic resistance, and the cost of health care.
Mi comentario:
en los útimos tiempos hemos tenido una serie de revisiones acerca del adecuado tratamiento de la sinusitis y en una de las últimas revisiones Cochrane (1) se hace mención del uso de esteroides nasales como primera línea de tratamiento o junto a los antibióticos, lo que mejora la resolución del cuadro y la mejoría de los pacientes, por lo que creo que este artículo es muy valioso ya que nos orienta mejor al tratamiento de esta patología tan frecuente.
Bibliografía:
1.- Anca Zalmanovici Trestioreanu, John Yaphe. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews, August 2011
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