Treatment of Mild to Moderate Sinusitis

Smith, Stephen R.; Montgomery, Lynda G.; Williams, John W

doi:10.1001/archinternmed.2012.253

Cited by 23 publications

(16 citation statements)

References 12 publications

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“…25 Most of the trials included in these meta-analyses selected patients using inclusion criteria that increased the likelihood of ABRS rather than viral sinusitis, such as positive radiographic findings. 5 …”

Section: Discussionmentioning

confidence: 99%

“…2 A growing body of evidence suggests that antibiotics do not confer a distinct clinical advantage in the vast majority of ARS cases, 1,3–5 and antibiotics are not recommended for most patients with mild cases of uncomplicated acute rhinosinusitis according to major consensus guidelines. 6–12 However, previous studies show that antibiotics are prescribed in 82% to 88% of patient visits for acute sinusitis, suggesting a substantial degree of antibiotic use.…”

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confidence: 99%

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

Smith

Kern

Chandra

et al. 2013

Otolaryngol.--head neck surg.

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Smith

Kern

Chandra

et al. 2013

Otolaryngol.--head neck surg.

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“…Groups reviewing the evidence for the antibiotic treatment of sinusitis recommend that symptoms be present for 7-10 days and not show signs of improvement before antibiotics are considered. 21,22 Ear pain and otitis media commonly accompany or follow the common cold, particularly in children. Findings on physical examination can be helpful in diagnosing otitis media (e.g., a bulging tympanic membrane has a likelihood ratio of 51), 23 and there are simple rules for prescribing antibiotics or using watchful waiting in children with possible otitis media.…”

Section: How Can the Common Cold Be Distinguished From Other Conditions?mentioning

confidence: 99%

Prevention and treatment of the common cold: making sense of the evidence

Allan

Arroll

2014

CMAJ

166

136

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“…Furthermore, it has been debated that the prescription rate is particularly high in Danish out-of-hours (OOH) primary care, especially in telephone consultations without subsequent face-to-face contact. This type of antibiotic prescription might be considered irrational as no good evidence supports antibiotic treatment for infectious conditions without prior medical examination [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

Huibers

Moth

Christensen

et al. 2014

Scandinavian Journal of Primary Health Care

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Objective. To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service. Design. Population-based observational registry study using routine registry data from the OOH registration system on patient contacts and ATC-coded prescriptions. Setting. The OOH primary care service in the Central Denmark Region. Subjects. All contacts with OOH primary care during a 12-month period (June 2010–May 2011). Main outcome measures. Descriptive analyses of antibiotic prescription proportions stratified for type of antibiotic, patient age and gender, contact type, and weekdays or weekend. Results. Of the 644 777 contacts registered during the study period, 15.0% received an antibiotic prescription: 26.1% resulted from clinic consultations, 10.7% from telephone consultations, and 10.9% from home visits. The prescription proportion was higher for weekends (17.6%) than for weekdays (10.6%). The most frequently prescribed antibiotic drugs were beta-lactamase sensitive penicillins (34.9%), antibiotic eye drops (21.2%), and broad-spectrum penicillins (21.0%). Most antibiotic eye drops (73%) were prescribed in a telephone consultation. Most antibiotics were prescribed at 4–6 p.m. on weekdays. Young infants received most antibacterial eye drops (41.3%), patients aged 5–17 years and 18–60 years received most beta-lactamase sensitive penicillins (44.6% and 38.9%, respectively), while patients aged 60 + years received most broad-spectrum penicillins (32.9% of all antibiotic prescriptions). Conclusion. Antibiotics were most often prescribed in clinic consultations, but, in absolute terms, many were also prescribed by telephone. The high prescription proportion, particularly antibacterial eye drops for young infants, suggests room for improvement in rational antibiotic use.

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Treatment of Mild to Moderate Sinusitis

Abstract: Antibiotics should not be prescribed for mild to moderate sinusitis within the first week of the illness. Avoiding antibiotics for acute sinusitis could reduce antibiotic adverse effects, antibiotic resistance, and the cost of health care.

Cited by 23 publications

References 12 publications

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

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

Prevention and treatment of the common cold: making sense of the evidence

Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

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