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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.

Second, the authors defined therapeutic success as the absence of a claim for a second antibiotic within 28 days. Appropriate antibiotic therapy has been shown to provide quicker resolution of symptoms than placebo in bacterial rhinosinusitis. Time . . . [Full Text of this Article]

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RELATED ARTICLE

Impact of First-Line vs Second-Line Antibiotics for the Treatment of Acute Uncomplicated Sinusitis
Jay F. Piccirillo, Douglas E. Mager, Mark E. Frisse, Robert H. Brophy, and Andrew Goggin
JAMA. 2001;286(15):1849-1856.
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