Antibiotic Treatment and Adverse Events in Acute Rhinosinusitis: A Long- term Nationwide Population-Based Cohort Study in South Korea

Abstract This study aimed to compare the risks of adverse events among the recommended antibiotic treatments for outpatients with acute sinusitis. This nationwide observational study used data from South Korea's National Health Insurance Services database (2010–2019) to examine antibiotic-related adverse events in adolescents and adults treated for acute rhinosinusitis. By employing a targeted trial emulation, we aimed to mitigate potential bias and improve causal inference. We used the inverse probability of treatment weighting and cloning-censoring-weighting methods to estimate the association between antibiotic agents and adverse events in observational studies. Primary treatment was associated with a higher risk of diarrhea and vaginitis than alternative antibiotics. The risk of vaginitis significantly increased with prolonged treatment across all antibiotic groups. Notably, the extended use of third-generation cephalosporins and quinolones further increased the risk of diarrhea. These findings highlight the importance of both antibiotic class and treatment duration in managing the adverse effects of non-sinusitis infections. In acute rhinosinusitis, the risk of vaginitis and diarrhea as microbiome-related adverse effects varied according to antibiotic class and treatment duration. These findings highlight the need for treatment strategies that balance safety and efficacy while prioritizing patient quality of life and long-term outcomes.