Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis.

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Abstract
Sinusitis is associated with significant morbidity, anxiety, reduced quality of life, lost time from work, and treatment expense. It is estimated that approximately 35 million US residents have some form of sinusitis, and in 1996 the direct cost of this disorder in the United States was more than $3.3 billion.1 McCaig and Hughes2 analyzed National Ambulatory Medical Care Surveys (NAMCS) data and found that acute and chronic sinusitis was the fifth most common diagnosis for which antibiotics were prescribed and also found an increasing trend of office visits between the years 1980 and 1992. In 1992 alone, sinusitis accounted for 12% of all recorded antibiotic prescriptions. There was a trend over time toward increased use of more expensive broad-spectrum antibiotics and decreased use of less expensive narrow-spectrum antibiotics. Ironically, this trend to prescribe more expensive antibiotics with a broader spectrum of action occurs despite evidence that about two thirds of patients with acute sinusitis improve or are cured without any antibiotics.3,4

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