Impact of First-Line vs Second-Line Antibiotics for the Treatment of Acute Uncomplicated Sinusitis

Piccirillo, Jay F.; Mager, Douglas E.; Frisse, Mark E.; Brophy, Robert H.; Goggin, Andrew

doi:10.1001/jama.286.15.1849

Cited by 93 publications

(62 citation statements)

References 35 publications

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“…These visits were termed ''index visits.'' Consistent with prior literature, [10][11][12][13] we identified the conditions by the following ICD-9 diagnosis codes: UTI, 595.0, 595. We looked at all diagnosis codes coded, as the order of diagnoses is typically not clinically important in outpatient visits in the system.…”

Section: Patient Population and Conditions Examinedmentioning

confidence: 88%

Characteristics of Patients Who Seek Care via eVisits Instead of Office Visits

Mehrotra

Paone²,

Martich

et al. 2013

Telemedicine and e-Health

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Purpose: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit. Materials and Methods: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9% of which were eVisits) and 2,954 UTI visits (3% eVisits). Results: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic ( >10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use. Conclusions: At these four primary care practices, eVisits accounted for almost 7% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons.

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Section: Patient Population and Conditions Examinedmentioning

confidence: 88%

Characteristics of Patients Who Seek Care via eVisits Instead of Office Visits

Mehrotra

Paone²,

Martich

et al. 2013

Telemedicine and e-Health

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“…Clinical guidelines for management of these common childhood infections include clear statements that neither macrolides nor third-generation cephalosporins are appropriate initial agents [14][15][16][17] and may contribute to increased costs of care. 44 Although use of these drugs may be considered in cases of penicillin allergy or for clinical failure of a first-line agent, understanding the driving forces for the upward trend in use of these broad-spectrum agents is vital to designing interventions to reduce their unwarranted use.…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in Outpatient Antibiotic Use in Children

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents. WHAT THIS STUDY ADDS:Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible.abstract OBJECTIVE: The goal of this study was to determine changes in antibiotic-dispensing rates among children in 3 health plans located in New England [A], the Mountain West [B], and the Midwest [C] regions of the United States. METHODS: Pharmacy and outpatient claims from September 2000 toAugust 2010 were used to calculate rates of antibiotic dispensing per person-year for children aged 3 months to 18 years. Differences in rates by year, diagnosis, and health plan were tested by using Poisson regression. The data were analyzed to determine whether there was a change in the rate of decline over time.RESULTS: Antibiotic use in the 3-to ,24-month age group varied at baseline according to health plan (A: 2.27, B: 1.40, C: 2.23 antibiotics per person-year; P , .001). The downward trend in antibiotic dispensing slowed, stabilized, or reversed during this 10-year period. In the 3-to ,24-month age group, we observed 5.0%, 9.3%, and 7.2% annual declines early in the decade in the 3 plans, respectively. These dropped to 2.4%, 2.1%, and 0.5% annual declines by the end of the decade. Third-generation cephalosporin use for otitis media increased 1.6-, 15-, and 5.5-fold in plans A, B, and C in young children. Similar attenuation of decline in antibiotic use and increases in use of broadspectrum agents were seen in other age groups.CONCLUSIONS: Antibiotic dispensing for children may have reached a new plateau. Along with identifying best practices in low-prescribing areas, decreasing broad-spectrum use for particular conditions should be a continuing focus of intervention efforts. 22 For children aged ,5 years, in whom antibiotic utilization is highest, an impressive 36% reduction in the use of antibiotics for RTIs occurred between 1995 and 2006. 23 It is unknown whether the previous downward trend in antibiotic use will continue or if a leveling off of prescribing will soon be reached. Stabilization of antibiotic use rates may be appropriate if principles of judicious use are being followed or it may signal the need for new interventions. A recent study from a limited number of communities in Massachusetts indicated that stabilization of dispensing has occurred in children aged ,6 years. 24 Because geographic variation exists in antibiotic prescribing, 21,25-27 we investigated trends in community antibiotic dispensing in children aged ,18 years insured by 3 geographically distinct health plans to examine whether rates have leveled off at these sites. We also explored trends in antibiotic utilization for common infect...

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“…In a previous primary care study, antibiotic treatment did not improve the clinical course of AMS (9). Despite limited research evidence on the effectiveness of antibiotics for AMS, this disease nevertheless is most often treated with antibiotics (10,11).…”

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confidence: 83%