{"id":2471,"date":"2012-02-14T20:55:19","date_gmt":"2012-02-15T01:55:19","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2471"},"modified":"2012-02-14T20:55:19","modified_gmt":"2012-02-15T01:55:19","slug":"is-it-time-to-stop-treating-acute-sinusitis","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/is-it-time-to-stop-treating-acute-sinusitis\/2012\/02\/14\/","title":{"rendered":"Is It Time To Stop Treating Acute Sinusitis?"},"content":{"rendered":"<p>From the pages of <em>JAMA <\/em>comes this <a href=\"http:\/\/jama.ama-assn.org\/content\/307\/7\/685.short\" target=\"_blank\">startling clinical trial<\/a>:<\/p>\n<blockquote><p>A randomized, placebo-controlled trial of adults\u00a0with uncomplicated, acute rhinosinusitis [who] were recruited from 10 community practices\u00a0in Missouri between November 1, 2006, and May 1, 2009 &#8230; [Subjects received a] ten-day course of either amoxicillin (1500 mg\/d) or placebo administered\u00a0in 3 doses per day &#8230;\u00a0<strong>There was no statistically significant difference in reported symptom improvement at day 3 (37% for amoxicillin group vs 34% for control group; p=.67) or at day 10 (78% vs 80%, respectively; p=.71).<\/strong><\/p><\/blockquote>\n<p>To be fair, I did leave out that outcomes favored the amoxicillin group at day 7. And I also left out that the validated instrument they used to gauge symptoms was called the &#8220;Sinonasal Outcome Test-16&#8221;, or &#8220;SNOT-16&#8221;<\/p>\n<p>Ahem.<\/p>\n<p>But still &#8212;\u00a0I&#8217;m willing to wager good money that if you asked 100 primary care providers, ENT specialists, ID doctors, and patients whether they thought antibiotics helped relieve symptoms of acute sinusitis, 90% would answer &#8220;yes.&#8221;<\/p>\n<p>And 99% would would want it for themselves.<\/p>\n<p>Critics of this study might quibble about the inclusion criteria, or the fairly large number of screened study subjects who were not enrolled, or the selection of amoxicillin over amoxicillin-clavulanate. What, no <em>Moraxella catarrhalis<\/em> coverage?<\/p>\n<p>Regardless, this\u00a0trials\u00a0reminds us that, even though it&#8217;s hard\u00a0to believe, the human species <em>did <\/em>survive many eons before the discovery of antibiotics in the 20th century, and that furthermore, most of the common community-acquired infections resolve spontaneously.<\/p>\n<p>Time will tell whether the results from the study will influence practice guidelines, patient perception, and &#8212; most importantly &#8212; clinical practice.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>From the pages of JAMA comes this startling clinical trial: A randomized, placebo-controlled trial of adults\u00a0with uncomplicated, acute rhinosinusitis [who] were recruited from 10 community practices\u00a0in Missouri between November 1, 2006, and May 1, 2009 &#8230; [Subjects received a] ten-day course of either amoxicillin (1500 mg\/d) or placebo administered\u00a0in 3 doses per day &#8230;\u00a0There was [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,10],"tags":[72,534,857],"class_list":["post-2471","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-research","tag-antibiotics","tag-jama","tag-sinusitis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2471","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2471"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2471\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2471"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2471"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}