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Letters
March 26, 2008

Antibiotics and Nasal Steroids for Acute Sinusitis—Reply

JAMA. 2008;299(12):1422-1423. doi:10.1001/jama.299.12.1423-a

In Reply: In response to Dr Rosenfeld, we agree that the Berg and Carenfelt criteria1 applied test characteristics are unknown in populations such as the one we studied. He is correct about the differences in study populations, although we think that most of these miss the essence of the sample studied by Berg and Carenfelt. The most prominent features of both studies are that they comprise patients with similarly acute and untreated sinusitis (although we consider it a limitation of the Berg and Carenfelt study that it used a mixed population, including some chronic patients and some treated with antibiotics). We are unaware of any other better published reference test that can be applied at the office visit or primary care setting2 where the vast majority of patients are seen and often receive unnecessary antibiotics (>90% prescribed3). Another study found that in the presence of 2 criteria, 82.7% of physicians reported they would prescribe antibiotics.4

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