Variations in Antibiotic Prescribing of Acute Rhinosinusitis in United States Ambulatory Settings

Abstract

Objective To identify variations in antibiotic treatment of acute rhinosinusitis (ARS) on a national level. Study Design Cross-sectional study of a national database. Setting Otolaryngology and primary care ambulatory settings. Subjects and Methods A nationally representative sample of adult outpatient visits was extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey data for 2006 to 2009. Antibiotic prescriptions associated with ARS were tabulated. Statistical analyses were conducted to identify variations in antibiotic prescribing by patient and physician characteristics. Results Antibiotics were prescribed in 82.3% ± 2.6% of 18.7 million visits for ARS (mean age, 46.2 years; 65.9% female). The ratio of primary care physician (PCP) to otolaryngologist (ENT) ARS visits was 18.6:1. Antibiotic prescription rates were inversely related to increasing age groups of 18 to 39, 40 to 64, and ≥65 years (87.8%, 81.2%, and 71.0%, respectively; P = .02). Physicians in general medicine outpatient departments, internal medicine, and family medicine were more likely to prescribe antibiotics compared with ENTs (adjusted odds ratio [OR], 7.9 [95% confidence interval (CI), 3.5–17.8]; 6.9 [2.5–19.2]; and 3.9 [2.0–7.7], respectively). The most commonly prescribed antibiotics were azithromycin, amoxicillin, and amoxicillin/clavulanate acid (27.5%, 15.5%, and 14.6%, respectively). The ENTs selected broad-spectrum antibiotics more often than PCPs (94.3% vs 75.7% of visits with antibiotics were broad-spectrum agents; P = .01). Conclusion Antibiotics were prescribed frequently despite recent consensus guidelines that discourage antibiotic use in mild cases. Furthermore, antibiotic prescription was more likely for younger patients and in primary care settings. This highlights the need to promote awareness of practice guidelines.

Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort

“…Overall, antibiotic use in this study was high and comparable that in other studies (86% vs. 75%–86%) . However, the strength of this study is the clinically detailed nature of our dataset, which allowed us to examine antibiotic use in a manner that has not been reported previously.…”

“…This study has significant limitations worth noting. There are important differences in our study methodology compared to studies based on a large cross‐sectional survey such as that available from the National Ambulatory Medical Care Survey (NAMCS) . Our study methodology entailed detailed review of clinical documentation from the patient encounter.…”

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

“…Just over half of the included studies were from the United States (n ϭ 15) (11,20,21,24,26,28,30,31,33,(38)(39)(40)(45)(46)(47), with the remainder from Canada (n ϭ 3) (34,37,43), The Netherlands (n ϭ 2) (29,35), Germany (n ϭ 2) (23, 42), Italy (n ϭ 1) (27), the United Kingdom (n ϭ 1) (25), Belgium (n ϭ 1) (22), and a network of 13 European countries (n ϭ 3) (36,41,44). Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46).…”

“…Eight of the U.S. studies used the NAMCS (National Ambulatory Medical Care Survey) or NHAMCS (National Hospital Ambulatory Medical Care Survey) data sets for their analyses (11,28,31,33,(38)(39)(40)46). Analyses included pediatric populations only in 5 studies (20,27,28,38,43) and adult populations only in 10 studies (11, 23-25, 39-42, 46, 47), while the rest either included all ages or did not specifically describe the patient population.…”

National burden of antibiotic use for adult rhinosinusitis

“…1–5 The role of antibiotics for chronic RS (CRS) is controversial, 2 and recent authors recommend objective evidence by endoscopy or CT should be obtained if a prolonged course of antibiotics are to be given for CRS. 6 However, previous studies show antibiotics are prescribed extensively to treat RS, in approximately over 80% of ARS 7 and 50% of CRS 8 patient visits.…”