Acute Sinusitis and Pharyngitis as Inappropriate Indications for Antibiotic Use

We read with interest the study by Donnelly and colleagues (1)which explored antibiotic prescriptions for ambulatory emer-gency department (ED) visits in the United States. As public health researchers, we agree with the authors ’ assertion that their findings “highlight opportunities for reducing inappropriate antibiotic use among adult ED ARTI [acute respiratory tract infection] patients and for optimizing treatment for antibiotic-appropriate ARTI ” (1). How-ever, these study results should be interpreted with one important clarification regarding the categories in which infections were classi-fied. In this work, the authors define “antibiotic-appropriate” ARTIs as otitis media, sinusitis, pharyngitis, and nonviral pneu-monia. However, it is well established that sinusitis and pharyn-gitis are caused predominantly by viral pathogens. In acute rhino-sinusitis, for instance, the incidence of bacterial infections is estimated to be only 2 % to 10%, with a secondary bacterial infec