The clinical diagnosis of acute bacterial rhinosinusitis in general practice and its therapeutic consequences.
In a randomized double-blind trial 251 adults with sinusitis-like symptoms were given amoxicillin/clavulanate or placebo for 6 days. Seven diagnostic indicators for acute bacterial rhinosinusitis are compared by their accuracy assuming a latent class model and by the treatment effect that they would have had if used to select a subset of patients for antibiotic treatment. Under a latent class model, radiography is a more efficient indicator then C reactive protein (CRP), which is, in turn, more efficient than other clinical signs and symptoms. However, a history of purulent nasal discharge, and signs of pus in the nasal cavity and throat, are better criteria than radiography or CRP for selecting those patients who will benefit from antibiotic treatment. These contradictory results are a salutary reminder that diagnostic indicators need to be evaluated in terms of therapeutic consequences for the patient.
Young
Jim
J
Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland. jyoung@uhbs.ch
Bucher
Heiner
H
Tschudi
Peter
P
Périat
Pierre
P
Hugenschmidt
Christa
C
Welge-Lüssen
Antje
A
D000208:Acute Disease; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005194:Family Practice; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D018579:Patient Selection; D012220:Rhinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
D015415:Biomarkers; D019980:Amoxicillin-Potassium Clavulanate Combination; D002097:C-Reactive Protein