DataMed Solutions, LLC, Hilliard, OH, USA.
Am J Rhinol Allergy. 2012 Jul-Aug;26(4):308-14. doi: 10.2500/ajra.2012.26.3781.
Antibiotics are frequently used to treat acute rhinosinusitis (ARS; acute sinusitis), although many episodes are viral. Because of community resistance concerns, current evidence provides limited support for the use of antibiotics in ARS. We conducted a retrospective comparative effectiveness outcomes assessment of the nasal steroid mometasone furoate nasal spray (MFNS) versus antibiotics among ARS patients in clinical practice.
Using the General Practice Research Database (United Kingdom), the earliest ARS event between January 1, 2005 and December 31, 2008 (index event) for patients aged 12-75 years and an antibiotic or MFNS prescription ±2 days was identified. Treatment cohorts were MFNS monotherapy (MM), MFNS + antibiotic (MAT), and antibiotic monotherapy (AM). Logistic regression adjusted for potential confounders and compared odds of rhinosinusitis-related medical encounters and related prescriptions in the 3- to 30-day postindex period.
There were 12,679 eligible patients (651 MM; 2285 MAT; 9743 AM). Compared with the reference cohort AM, during the 3- to 30-day postindex period, lower adjusted odds (p < 0.001) of having one or more rhinosinusitis-related medical encounters was observed for MM (odds ratio [OR] = 0.39; 95% CI, 0.26-0.58) and MAT (OR = 0.51; 95% CI, 0.42-0.62); having one or more rhinosinusitis-related prescriptions for MM (OR = 0.51; 95% CI, 0.42-0.63) and MAT (OR = 0.58; 95% CI, 0.52-0.65); having one or more antibiotic, nasal steroid, or oral steroid prescriptions for MM (OR = 0.36; 95% CI, 0.28-0.46) and MAT (OR = 0.51; 95% CI, 0.46-0.58); and having one or more antibiotic prescriptions for MM (OR = 0.43; 95% CI, 0.33-0.58) and MAT (OR = 0.63; 95% CI, (0.55-0.72).
Compared with AM, using MFNS for initial ARS treatment, alone or with an antibiotic, is associated with a decreased likelihood of both subsequent rhinosinusitis-related medical encounters and use of related prescriptions.
抗生素常被用于治疗急性鼻-鼻窦炎（ARS；急性鼻窦炎），尽管许多病例为病毒性。由于社区耐药问题，目前的证据对 ARS 中使用抗生素的支持有限。我们对临床实践中 ARS 患者中鼻腔用皮质类固醇糠酸莫米松鼻喷雾剂（MFNS）与抗生素的比较有效性结局进行了回顾性评估。
使用全科医学研究数据库（英国），在 2005 年 1 月 1 日至 2008 年 12 月 31 日之间（索引事件），为年龄在 12-75 岁之间的患者确定最早的 ARS 事件，并记录抗生素或 MFNS 处方的 ±2 天。治疗队列包括 MFNS 单药治疗（MM）、MFNS+抗生素（MAT）和抗生素单药治疗（AM）。使用逻辑回归对潜在混杂因素进行调整，并比较了索引后 3-30 天内鼻-鼻窦炎相关医疗接触和相关处方的几率。
共纳入 12679 例符合条件的患者（651 例 MM；2285 例 MAT；9743 例 AM）。与参考队列 AM 相比，在索引后 3-30 天内，MM（比值比 [OR] = 0.39；95%置信区间，0.26-0.58）和 MAT（OR = 0.51；95%置信区间，0.42-0.62）观察到较低的调整后发生一次或多次鼻-鼻窦炎相关医疗接触的几率；MM（OR = 0.51；95%置信区间，0.42-0.63）和 MAT（OR = 0.58；95%置信区间，0.52-0.65）的一次或多次鼻-鼻窦炎相关处方；MM（OR = 0.36；95%置信区间，0.28-0.46）和 MAT（OR = 0.51；95%置信区间，0.46-0.58）一次或多次抗生素、鼻腔用皮质类固醇或口服皮质类固醇处方；MM（OR = 0.43；95%置信区间，0.33-0.58）和 MAT（OR = 0.63；95%置信区间，0.55-0.72）的一次或多次抗生素处方。
与 AM 相比，在初始 ARS 治疗中使用 MFNS，单独使用或联合使用抗生素，与降低后续鼻-鼻窦炎相关医疗接触和相关处方的几率相关。
