Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002

Objective: To generalize the prescribing trends of a statistically defined sample of patient visits because of acute or chronic rhinosinusitis in the United States, using reported diagnostic codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Design: Four-year prospective study. Setting: Public use data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey collected by the National Center for Health Statistics. Results: The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant, and mucolytic agents, respectively. In addition, corticosteroids are used for the treatment of chronic rhinosinusitis. Conclusions: The use of prescription antibiotics far outweighs the predicted incidence of bacterial causes of acute and chronic rhinosinusitis. Frequency of antibiotic class used was not congruent with reported antimicrobial efficacy of the respective classes. Despite contradictory efficacies reported in the literature, inhaled corticosteroids were frequently used to treat acute rhinosinusitis. Antibiotics and inhaled nasal corticosteroids are being used more often than their published efficacies would encourage.