March 26, 2018
2 min read

Physicians frequently overprescribe antibiotics for sinusitis

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Katherine Fleming-Dutra

The duration of antibiotic therapy for adults with sinusitis often exceeds current guideline recommendations, according to research published in JAMA Internal Medicine.

“Improving the way physicians prescribe antibiotics is important for patient safety, helps fight antibiotic resistance and ensures that life-saving antibiotics will be available for future generations,” Katherine Fleming-Dutra, MD, senior author of the study and deputy director of the CDC’s Office of Antibiotic Stewardship, told Healio Internal Medicine.

The researchers hypothesized that an antibiotic stewardship opportunity may lie in guideline-concordant treatment duration.

Fleming-Dutra and colleagues sought to determine the appropriate duration of antibiotic therapy for the treatment of acute sinusitis in adult outpatients. The researchers used the 2016 National Disease and Therapeutic Index to identify internal medicine, family practice, general practice, geriatrics, pediatrics and emergency medicine visits where physicians prescribed a new oral antibiotic to adults diagnosed with acute sinusitis. They categorized antibiotics as penicillins, tetracyclines, fluoroquinolones, cephalosporins, azithromycin or other.

The researchers identified 3,696,976 visits that met eligibility criteria. Antibiotic therapy was taken for a median duration of 10 days (interquartile range, 7-10 days). Approximately 70% of antibiotics were prescribed for 10 days or more.

More than 20% of prescriptions were for a 5-day treatment duration of azithromycin which go against the Infectious Diseases Society of America’s (IDSA) recommendation that azithromycin not be used for sinusitis because it is known to increase the risk for developing drug resistance, according to the researchers.

In analyses excluding azithromycin prescriptions, most antibiotic courses (91.5%) lasted 10 days or more, while 7.6% lasted 7 days and 0.5% lasted 5 days.

These findings show that more than two-thirds of antibiotic prescriptions for sinusitis are used for longer than the current IDSA recommendations, which advise that physicians prescribe 5 to 7 days of therapy for patients with acute bacterial sinusitis who have a low risk for antibiotic resistance.

“Patients should be diagnosed with sinus infections only if they meet strict diagnostic criteria as outlined in national guidelines issued by the Infectious Diseases Society of America and the American Academy of Otolaryngology-Head and Neck Surgery,” Fleming-Dutra said. “Many sinus infections will get better without antibiotics. Watchful waiting, in which the patient is watched for a few days to see if they get better before deciding whether antibiotics are needed, is a recommended treatment strategy for sinus infections that can reduce unnecessary antibiotic use.”

Fleming-Dutra emphasized that physicians only prescribe antibiotics when needed. When antibiotics are necessary, the right antibiotic at the right dose for the minimum number of days needed should be used, she said.

“Most patients with sinus infections can be effectively treated with 5 to 7 days of antibiotics (not azithromycin),” she noted.

“CDC recommends that clinicians implement antibiotic stewardship, which is the effort to measure and improve antibiotic use,” Fleming-Dutra added. “CDC’s Core Elements of Outpatient Antibiotic Stewardship provide a framework for how clinicians can implement antibiotic stewardship in their outpatient practices.”– by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.