Impact of first-line vs second-line antibiotics for the treatment of acuteuncomplicated sinusitis

Context Studies suggest little benefit in relief of acute sinusitis symptom s from the use of newer and more expensive (second-line) antibiotics instea d of older and less expensive (first-line) antibiotics. However, researcher s have failed to include development of complications and cost of care in t heir analyses. Objective To compare the effectiveness and cost of first-line with second-l ine antibiotics for the treatment of acute uncomplicated sinusitis in adult s. Design, Setting, and Patients Retrospective cohort study using a pharmaceut ical database containing demographic, clinical (International Classificatio n of Diseases, Ninth Revision), treatment, and charge information for 29102 adults with a diagnosis of acute sinusitis receiving initial antibiotic tr eatment between July 1, 1996, and June 30, 1997. Main Outcome Measures Absence of additional claim for an antibiotic in the 28 days after the initial antibiotic, presence of a claim for a second anti biotic, serious complications of sinusitis, and direct charges and use for the acute sinusitis treatment. Results There were 17 different antibiotics prescribed in this study. The m ajority (59.5%) of patients received 1 of the first-line antibiotics. The o verall success rate was 90.4% (95% confidence interval [CI], 90.0%-90.8%). The success rate for the 17 329 patients who received a first-line antibiot ic was 90.1% and for the 11773 patients who received a second-line antibiot ic was 90.8%, a difference of 0.7% (95% CI, 0.01%-1.40%; P<.05). There were 2 cases of periorbital cellulitis, one in each treatment group. The averag e total direct charge for patients receiving a first-line antibiotic was $6 8.98 and a second-line antibiotic was $135.17, a difference of $66.19 (95% Cl, $64.95-$67.43; P<.001). This difference was due entirely to the differe nce in charge of antibiotics and not other charges, such as professional fe es, laboratory tests, or emergency department visits. Conclusions Patients treated with a first-line antibiotic for acute uncompl icated sinusitis did not have clinically significant differences in outcome s vs those treated with a second-line antibiotic. However, cost of care was significantly higher for patients treated with a second-line antibiotic.