In Reply: We clearly acknowledged all of the
methodological limitations cited by Dr Anon and colleagues. For example, we
were unable to confirm the actual diagnosis of acute bacterial sinusitis and
therefore patients included in our study may not have had this diagnosis.
However, it is common in clinical practice to initiate antimicrobial therapy
for presumed sinusitis without confirmation from radiological or microbiological
studies. Time to resolution of symptoms is but one of many reasonable outcomes
to select for the definition of treatment response in sinusitis. We selected
the absence of a claim for a second antibiotic within 28 days as our primary
outcome measure. This outcome is clinically reasonable and has been used in
other studies using pharmacy and administrative databases.1
We agree that the failure to define severity of disease was a limitation of
our study. However, given the particular subset of patients with sinusitis
in our study, we believe this was a minor limitation. For example, the Sinus
and Allergy Health Partnership (SAHP)2 antibiotic
treatment guidelines for patients similar to ours—those with acute sinusitis
and no antibiotic use in the prior 4 to 6 weeks—make no distinction
in recommended antibiotics based on symptom severity. The SAHP-recommended
antibiotics are amoxicillin, amoxicillin/clavulanate potassium, cefpodoxime
proxetil, and cefuroxime axetil.
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