To the Editor: Dr Piccirillo and colleagues1 found that second-line antibiotics were no more
effective than first-line antibiotics in the treatment of acute rhinosinusitis,
although they were associated with significantly higher costs. However, we
believe that these conclusions are not justified due to inadequate study design.
First, this was a retrospective study of adults in a proprietary database
with a diagnosis code of acute rhinosinusitis and a concurrent prescription
for antibiotics. No diagnostic standard or chart review was used.2,3 Other studies of similar unselected
patient populations have shown that 50% or more of patients with a presumed
diagnosis of bacterial sinusitis actually have a viral infection and should
not be treated with antibiotics.
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