Trends and Frequencies of Antibiotic Prescriptions for Acute Sinusitis Outpatient Visits in Adults

Abstract

ObjectiveThe objective of this study was to analyze the trends and frequency in which recommended first‐line therapy, amoxicillin with or without clavulanate, was prescribed for acute sinusitis based on current otolaryngology and other gold standard guidelines, as well as analyze differences in prescription behaviors of otolaryngologists compared with non‐otolaryngologists for outpatient adult acute sinusitis visits.MethodsWeighted patient data from the National Ambulatory Medical Care Survey were analyzed to calculate visit rates and trends of antibiotic prescriptions for adults diagnosed with acute sinusitis from 2007 to 2019. Visits with multiple prescribed antibiotics or concomitant diagnoses requiring antibiotics were excluded. Each visit was classified based on the type of antibiotic prescribed.ResultsAcute sinusitis was diagnosed in 0.63% of all outpatient visits from 2007 to 2019 (95% confidence interval: 0.56%–0.71%). Amoxicillin had the greatest increase in prescription frequency (13.4%), whereas macrolides had the largest decrease in prescription frequency (13.9%). Among adult acute sinusitis outpatient visits in which antibiotics were prescribed, recommended first‐line antibiotic therapy of amoxicillin‐clavulanate or amoxicillin alone was prescribed in 40.4% of visits. The most common antibiotic prescribed was amoxicillin‐clavulanate at otolaryngologist visits (20.5%) and macrolides at non‐otolaryngologist visits (26.0%). A greater proportion of otolaryngologist visits resulted in no antibiotics prescribed for acute sinusitis (36.8% vs. 22.5%, p < 0.001).ConclusionOtolaryngologists engage in watchful waiting more than non‐otolaryngologists. Broader dissemination of existing guidelines for acute sinusitis treatment to non‐Otolaryngologist (ENT) primary care specialties that take care of acute sinusitis to improve antibiotic stewardship and appropriate antibiotic selection is needed.Level of Evidence4 Laryngoscope, 2023