A Retrospective Comparison of Acute Rhinosinusitis Outcomes in Patients Prescribed Antibiotics, Mometasone Furoate Nasal Spray, or Both

Background Antibiotics are frequently used to treat acute rhinosinusitis (ARS; acute sinusitis), although many episodes are viral. Because of community resistance concerns, current evidence provides limited support for the use of antibiotics in ARS. We conducted a retrospective comparative effectiveness outcomes assessment of the nasal steroid mometasone furoate nasal spray (MFNS) versus antibiotics among ARS patients in clinical practice. Methods Using the General Practice Research Database (United Kingdom), the earliest ARS event between January 1, 2005 and December 31, 2008 (index event) for patients aged 12–75 years and an antibiotic or MFNS prescription ±2 days was identified. Treatment cohorts were MFNS monotherapy (MM), MFNS + antibiotic (MAT), and antibiotic monotherapy (AM). Logistic regression adjusted for potential confounders and compared odds of rhinosinusitisrelated medical encounters and related prescriptions in the 3- to 30-day postindex period. Results There were 12,679 eligible patients (651 MM; 2285 MAT; 9743 AM). Compared with the reference cohort AM, during the 3- to 30-day postindex period, lower adjusted odds (p < 0.001) of having one or more rhinosinusitis-related medical encounters was observed for MM (odds ratio [OR] = 0.39; 95% CI, 0.26–0.58) and MAT (OR = 0.51; 95% CI, 0.42–0.62); having one or more rhinosinusitis-related prescriptions for MM (OR = 0.51; 95% CI, 0.42–0.63) and MAT (OR = 0.58; 95% CI, 0.52–0.65); having one or more antibiotic, nasal steroid, or oral steroid prescriptions for MM (OR = 0.36; 95% CI, 0.28–0.46) and MAT (OR = 0.51; 95% CI, 0.46–0.58); and having one or more antibiotic prescriptions for MM (OR = 0.43; 95% CI, 0.33–0.58) and MAT (OR = 0.63; 95% CI, (0.55–0.72). Conclusion Compared with AM, using MFNS for initial ARS treatment, alone or with an antibiotic, is associated with a decreased likelihood of both subsequent rhinosinusitis-related medical encounters and use of related prescriptions.