Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations

Jørgensen, Lars; Christensen, Sarah Friis; Córdoba, Gloria; Llor, Carles; Bjerrum, Lars

doi:10.3109/02813432.2013.788270

Cited by 26 publications

(28 citation statements)

References 23 publications

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“…A recent study performed in six countries also showed high rates of antibiotic prescribing in patients with acute sinusitis, ranging from 56% to 87% [6]. About 80% of sinusitis have a viral aetiology, and only a very small percentage is complicated by bacterial infection [15].…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Malo

Bjerrum

Feja

et al. 2014

Basic Clin Pharma Tox

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Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bacterial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evaluating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and antibiotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifaceted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.Antimicrobial resistance is a major concern to the public health and may result from indiscriminate or poor use of antibiotics [1].Infectious diseases are the most frequent reason for encounter in primary care, and respiratory tract infections (RTIs) account for about two-thirds of all infections seen by the general practitioner (GP) [2]. Despite the fact that the benefit of antimicrobial treatment is rather low [3,4], a substantial number of patients with RTI are treated with antibiotics [5,6]. Diagnostic uncertainty characterizes the management of RTIs and doubt about the diagnosis and the aetiology may lead to antibiotic over-prescribing. Other factors such as patient preferences, fears of getting sued and fear of serious complications may influence the GP's prescribing decision [7].Studies have found a substantial gap between recommendations in evidence-based practice guidelines and doctors' actual prescribing behaviour [8].Compared with other European countries, Spain has historically displayed a high outpatient antibiotic use. The majority of antibiotics prescribed are broad-spectrum agents, and there are remarkable seasonal fluctuations reflecting an inappropriate prescribing of antibiotic for RTIs caused by viruses [9]. Consequently, resistance rates of the main respiratory pathogens remain high in Spain, although a decreasing trend has been observed in the last years [10].According to the disease-specific quality indicators for outpatient antibiotic prescribing developed by the European Surveillance Antimi...

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Section: Comparison With Existing Literaturementioning

confidence: 99%

“…Despite the fact that the benefit of antimicrobial treatment is rather low [3,4], a substantial number of patients with RTI are treated with antibiotics [5,6]. Diagnostic uncertainty characterizes the management of RTIs and doubt about the diagnosis and the aetiology may lead to antibiotic over-prescribing.…”

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confidence: 99%

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Malo

Bjerrum

Feja

et al. 2014

Basic Clin Pharma Tox

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“…EPOS has inspired researchers to use standard definitions of disease, study the epidemiology and management of ARS and CRS, reduce unnecessary (mainly antibiotic) treatment and form new collaborations to answer unmet research questions (9,(21)(22)(23)(24)(25)(26) . EPOS2020 will build on this success.…”

Section: Introductionmentioning

confidence: 99%

Development of a new psychophysical method to assess intranasal trigeminal chemosensory function

Huart¹,

Hummel²,

Kaehling³

et al. 2019

Rhin

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Background:The European Position Papers on Rhinosinusitis from 2005, 2007 and 2012 have had a measurable impact on the way this common, yet burdensome condition is diagnosed and treated around the world. EPOS2020 will be the latest iteration of the guideline, addressing new stakeholders and target users, presenting a summary of the latest literature and evolving treatment modalities, and formulating clear recommendations based on all available evidence.Methodology: Based on the AGREE II framework, this article demonstrates how the EPOS2020 steering group will address six key areas to ensure consistency in quality and presentation of information in the latest rhinosinusitis clinical practice guideline: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; recommendations and applicability; editorial independence.Results: By analysing the guidance from AGREE II we have formulated a detailed development strategy for EPOS2020. We identify new stakeholders and target users and ratify the importance of patient involvement in the latest EPOS guideline. New and expanded areas of research to be addressed are highlighted. And we confirm our intention to use mixed methodologies, combining evidence-based medicine with expert opinion to achieve clear, inclusive recommendations. We also introduce new concepts for dissemination of the guideline, making use of the Internet and social media to improve accessibility. Conclusion:This article is an introduction to the EPOS2020 project, and presents the key goals, core stakeholders, planned methodology and dissemination strategies for the latest version of this influential guideline.Logo designed by Benoit Pugin.*Please note, we are actively recruiting new members to represent patients, health economists and methodology (GRADE) expertise.

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“…Viral URTI or allergic rhinitis may lead to secondary bacterial infection of the sinuses. Viral URTI or allergic rhinitis may lead to secondary bacterial infection of the sinuses in about 0.5–2% of cases (6–13% in children) . In bacterial sinusits, Streptococcus pneumoniae , Haemophilus influenzae , and/or Moraxella catarrhalis are common causative organisms .…”

Section: Introductionmentioning

confidence: 99%

“…Viral URTI tends to be self‐limiting, and the treatment is symptomatic (analgesics, antipyretics and/or decongestants) . There is widespread over‐prescription of antibiotics in ARS, which are usually ineffective since most cases represent viral URTI. One evidence‐based protocol advocated that clinicians assume the aetiology of rhinosinusitis is viral if symptoms have been present for less than 10 days and are not worsening.…”

Section: Introductionmentioning

confidence: 99%

Rhinosinusitis in oral medicine and dentistry

Ferguson¹

2014

Aust Dent J

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Rhinosinusitis is a very common condition which is normally readily recognizable. Given the intimate anatomic relationship between the antrum and the posterior maxillary teeth, maxillary sinusitis can present as odontalgia. Distinguishing between odontogenic orofacial pain and pain associated with maxillary sinusitis is important to prevent unnecessary dental intervention and to direct patients to medical colleagues. Conversely, odontogenic infection can spread to involve the antrum, termed odontogenic sinusitis, or maxillary sinusitis of dental origin. Odontogenic sinusitis accounts for about 10-40% of all cases of sinusitis, and usually requires combined dental and medical treatment. Maxillary sinusitis can also be a complication of exodontia, resulting from tuberosity fractures, displaced teeth or root fragments and the creation of oroantral communications and fistulae. Dental implants and endodontic materials can also impinge on the maxillary sinus, and are rare causes of sinusitis. Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. However, gold standards in halitotosis research such as organoleptic assessment or gas chromatography have not been used to validate a correlation between objective (genuine) halitosis and sinusitis. The pathophysiology of this mechanism is unclear, and the relative importance of this alongside other causes of extraoral halitosis is debated.Keywords: Halitosis, maxillary sinusitis, odontogenic sinusitis, oronantral communication, rhinosinusitis, sinusitis.Abbreviations and acronyms: ARS = acute rhinosinusitis; CRS = chronic rhinosinusitis; FESS = functional endoscopic sinus surgery; OAC = oroantral communication; OAF = oroantral fistula; URTI = upper respiratory tract infection; VSC = volatile sulfur compound.

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Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations

Cited by 26 publications

References 23 publications

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Compliance with Recommendations on Outpatient Antibiotic Prescribing for Respiratory Tract Infections: The Case of Spain

Development of a new psychophysical method to assess intranasal trigeminal chemosensory function

Rhinosinusitis in oral medicine and dentistry

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