Open Forum Infect Dis

Acute sinusitis: How and where antibiotics are misprescribed

August 26, 2024

Most acute sinusitis encounters resulted in an antibiotic prescription—and nearly a third of those antibiotics weren’t concordant with guideline-recommended options—in this nationwide outpatient claims data cohort study. In cases where guideline-concordant first-line antibiotics were prescribed, 75% were for durations >7 days, exceeding guideline recommendations. Rural settings and urgent care sites showed greater opportunities for improvement.

• Researchers examined national claims data on 4,689,850 outpatient sinusitis encounters in adults aged 18-64 years, from 2016-2020. Guideline concordance included antibiotics classified as first-line (amoxicillin-clavulanate, amoxicillin) or second-line (doxycycline, levofloxacin, moxifloxacin), as well as antibiotic duration ≤7 days. Researchers did not have access to clinical details that led to diagnosis.
• Sinusitis encounters involved a guideline-concordant antibiotic in 53%, a guideline-discordant antibiotic in 30%, and no antibiotic prescription in 17%. Although clinical guidelines recommend against macrolides for acute sinusitis, azithromycin was the second-most prescribed antibiotic in this study. In terms of duration, around 75% of first-line antibiotics and 63% of second-line antibiotics were prescribed for >7 days, exceeding guideline recommendations.
• In rural areas, antibiotic selections were less likely to be guideline-concordant (adjusted risk ratio [aRR], 0.92); as were durations of therapy (aRR, 0.77). In urgent care settings, durations were less likely to be guideline-concordant vs. office settings (aRR, 0.76). However, most emergency department sinusitis encounters resulted in no antibiotic prescription (57.3%).
• Researchers noted that watchful waiting and delayed prescribing are strategies that are reasonable for initial management of acute sinusitis when symptoms are mild in patients who don’t meet stringent clinical criteria for bacterial infections.

Source:

Vazquez Deida AA, et al. (2024, July 23). Open Forum Infect Dis. Opportunities to Improve Antibiotic Prescribing for Adults With Acute Sinusitis, United States, 2016-2020. https://pubmed.ncbi.nlm.nih.gov/39100530/