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June 13, 2012

Acute Rhinosinusitis Treatment

Author Affiliations

Author Affiliations: University of Wisconsin School of Medicine and Public Health, Madison (demuri@pediatrics.wisc.edu).

JAMA. 2012;307(22):2368-2370. doi:10.1001/jama.2012.4391

To the Editor: Dr Garbutt and colleagues concluded based on a recent trial that treatment of patients with clinically diagnosed acute rhinosinusitis with amoxicillin for 10 days offered little clinical improvement over placebo.1 We have concerns that the study methods confound the conclusions.

First, the criteria used in diagnosing sinusitis, although promulgated by the Centers for Disease Control and Prevention, may be overly broad. Participants were diagnosed with sinusitis if they had maxillary pain or tenderness in the face or teeth, purulent nasal discharge, and rhinosinusitis symptoms lasting 7 days or more. It has been shown that the mean duration of an uncomplicated upper respiratory tract infection in young children is 6.6 to 8.9 days.2 Including patients who have symptoms for less than 10 days may result in including those who have an uncomplicated viral illness and are thus not likely to respond to antimicrobial agents

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