Clinical and fiscal tolls of inappropriate antibiotic prescribing for sinus conditions

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

From Otolaryngology — Head and Neck Surgery

A growing body of evidence suggests that antibiotics do not offer a distinct clinical advantage in the vast majority of acute rhinosinusitis (ARS) cases. Antibiotics are not recommended for most patients with mild cases of uncomplicated APS according to major consensus guidelines. There may be consequences to individuals, including allergic reactions and medication side effects. Excessive antibiotic use is also associated with consequences to society as a whole, in the form of unnecessary costs and increasing bacterial resistance

Previous studies show that antibiotics are prescribed in 82% to 88% of patient visits for acute sinusitis, suggesting a substantial degree of antibiotic use. The goal of this study was to analyze on a national level the overall utilization of antibiotic treatment for ARS and identify variations by provider specialty. Information regarding prescribing patterns could direct efforts to improve the quality and quantity of prescribing. A nationally representative sample of adult outpatient visits was extracted from national studies. Statistical analyses were conducted to identify variations in antibiotic prescribing by patient and physician characteristics. This study supports the findings of previous studies that antibiotics are prescribed frequently for ARS, particularly in younger patients and primary care settings, despite recent consensus guidelines that discourage antibiotic use in mild cases. These variations should be of high relevance to policy makers, patients, and clinicians, with implications for payment for quality.

 

 

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.

 

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Article details
Stephanie Shintani Smith, MD1,2, Robert C. Kern, Rakesh K. Chandra, Bruce K. Tan, & Charlesnika T. Evans (2013). Variations in Antibiotic Prescribing of Acute Rhinosinusitis in United States Ambulatory Settings Otolaryngology — Head and Neck Surgery, 148 (5) DOI: 10.1177/0194599813479768

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