Examination of antibiotic dosing practices for refractory rhinosinusitis in relation to body weight.

OBJECTIVE Rhinosinusitis is a common condition that is frequently treated as an infectious disease with antibiotics. In general, antibiotic dosing in adults follows a flat scheme with no regard for body size. Wide variability in body weight raises concern whether this dosing scheme results in efficacious dosing for patients of various sizes. If not, larger patients with chronic rhinosinusitis may have avoidable morbidity from their disease, and surgery may be prematurely recommended. Our goal was to better understand the possible treatment implications of varying body size when prescribing antibiotics for chronic rhinosinusitis. DESIGN Retrospective chart review. SETTING Otolaryngology referral center at a multispecialty medical center. PARTICIPANTS Patients (N = 180) with refractory chronic rhinosinusitis referred to an otolaryngologist for consideration of sinus surgery. METHODS Main outcome measures included antibiotic usage, dosing, and body size metrics. RESULTS There was wide variation in patient weight and body mass index. However, treatment guidelines for adults do not recommend dosage adjustments for variation in weight, and there was little variation in dosing strategies for each antibiotic prescribed. Therefore, per kilogram dosing varied widely between patients. Of the 9 antibiotics prescribed for chronic rhinosinusitis, the median per kilogram dose of only 1 antibiotic exceeded the minimum recommended per kilo-gram dose for children. CONCLUSION In the absence of weight-based guidelines for antibiotic administration, the potential for suboptimal dosing in patients seeking relief for chronic rhinosinusitis or other infectious diseases is great, and further study is needed to examine dosing practices.