Effectiveness of Mometasone Furoate Nasal Spray with or without Antibiotics vs. Antibiotic Monotherapy in Patients with Acute Rhinosinusitis in the United Kingdom

RATIONALE: Antibiotics are frequently used to treat acute rhinosinusitis (ARS) although many episodes are viral. We sought to evaluate the effectiveness of mometasone furoate nasal spray (MFNS) vs. antibiotics among ARS patients in clinical practice. METHODS: Using the General Practice Research Database (GPRD), the earliest ARS event between 1/1/2005-12/31/2008 (index event) for patients with age 12-75 years; ≥2 years of GPRD registration and; an antibiotic or MFNS prescription within 2 days of index event. Cohorts were MFNS monotherapy (MM); MFNS+antibiotic (MAT) and; antibiotic monotherapy (AM). Logistic regression was used to adjust for potential confounders and compare odds of post-index ARS-related medical visits and related prescriptions. The AM cohort was reference for all comparisons. RESULTS: In total, 12,864 patients (652 MM; 2,282 MAT; 9,930 AM) were identified. A lower adjusted odds ratio (OR) of ≥1 ARS-related medical visit 3-30 days post-index was observed for both MM [OR=0.38 (95% CI 0.25, 0.57)] and MAT [OR=0.51 (0.42, 0.63)] compared to AM. A lower OR of ≥1 rhinosinusitis-related prescription 3-30 days post-index was found for both MM [OR=0.49 (0.41, 0.60)] and MAT [OR=0.56 (0.51, 0.63)] compared to AM. A lower OR of ≥1 antibiotic, nasal steroid or oral steroid prescription 3-30 days post-index was seen for both MM [OR=0.35 (0.28, 0.45) and MAT [OR=0.51 (0.46, 0.58)] compared to AM. All comparisons were statistically significant (p≤0.001). CONCLUSIONS: Compared to antibiotic monotherapy, using MFNS for initial ARS treatment, alone or with an antibiotic, may decrease the likelihood of both subsequent ARS-related medical encounters and subsequent use of related prescriptions.