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Letters
June 13, 2012

Acute Rhinosinusitis Treatment—Reply

Author Affiliations

Author Affiliations: Departments of Medicine (Dr Garbutt; jgarbutt@dom.wustl.edu), Mathematics (Dr Spitznagel), and Otolaryngology–Head and Neck Surgery (Dr Piccirillo), Washington University School of Medicine, St Louis, Missouri.

JAMA. 2012;307(22):2368-2370. doi:10.1001/jama.2012.4393

In Reply: Dr Sun and colleagues and Drs DeMuri and Wald raise concerns about our study: the diagnostic criteria may have failed to exclude those with a cold; the dose of amoxicillin may have been inadequate; a broader-spectrum antibiotic may have been indicated; and the use of symptomatic treatments was inappropriate.

Because our goal was to determine if the clinical guidelines1 for the management of acute rhinosinusitis effectively identified those who would benefit from antibiotic treatment, we used those diagnostic criteria. We think it is unlikely that most patients simply had a cold because the median symptom duration was 10 days (mean, 11.2 days) and all participants described their symptoms as moderate or severe, not improving, or worsening.

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