Back to basics

As we continue to get blitzed with happy-meal style medications like Azithromycin Z-paks and Tri-paks, Biaxin XL-paks, and Levaquin Leva-paks, consider the most recent review from NEJM on bacterial sinusitis. Some excerpts:

In an analysis of a large pharmaceutical database, 29,102 patients were identified with a billing diagnosis of acute sinusitis and a related prescription for an antimicrobial agent. Clinical success was defined as the absence of an additional prescription for an antimicrobial agent within 28 days after the initial prescription. The success rate was 90.1 percent for the patients who received older antimicrobial agents (e.g., amoxicillin, trimethoprim-–sulfamethoxazole, and erythromycin) and 90.8 percent for the patients who received newer drugs (e.g., clarithromycin, azithromycin, and amoxicillin–-clavulanate). Serious complications (such as brain abscess and meningitis) occurred in one patient in each group. The average pharmaceutical charge was $18 for patients receiving older antimicrobial agents and $81 for those receiving newer antimicrobial agents.

In other words, this retrospective study suggests equivalent efficacy between “older” (i.e. amox, bactrim, erythro) and “newer” (i.e. biaxin, azithromycin, augmentin) antibiotics with the older antibiotics costing 1/4th as much. Bottom line from the article:

For patients who have “severe or persistent moderate” symptoms (these terms are not defined in the guidelines but are generally considered sufficient to result potentially in lost workdays) and in whom there are specific findings of bacterial sinusitis, amoxicillin, doxycycline, or trimethoprim–sulfamethoxazole should be prescribed as reasonable first-line therapy.

Just thought I’d give generic antibiotics a plug, since they don’t have the marketing budget the drug companies do.

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