Nonclinical Factors Influence Antibiotic Overuse in Acute Sinusitis

What nonclinical factors are associated with antibiotic use for acute sinusitis?

Background: Sinusitis, usually a viral infection, is one of the most common conditions treated by primary care providers. Despite their lack of efficacy, antibiotics are pervasively overused for sinusitis, resulting in widespread antibiotic resistance. Decreasing antibiotic use for uncomplicated sinusitis is an important focus of antimicrobial stewardship.

Study design: Retrospective cohort at a single academic institution of 1,272 adult patients diagnosed with acute sinusitis between Jan. 1, 2005, and Dec. 31, 2006.

Setting: University of Michigan Health System, Ann Arbor.

Synopsis: Similar proportions of patients had symptoms for greater than 10 days versus fewer than 10 days, and the rest were undocumented. Common symptoms included facial pressure, rhinorrhea, nasal obstruction, pain, and patient-reported fever; documented fever was very uncommon. Provider analysis found similar proportions of internal medicine and family medicine and fewer emergency medicine providers. Most were women, with a mean of 11.6 years in practice. Antibiotic prescriptions were given to 86.1% patients overall; 69.9% of patients with mild symptoms of short duration were given an antibiotic. Among patients treated with antibiotics, 33.6% were given broad-spectrum therapy. No patient who was initially managed without antibiotics received an antibiotic within the subsequent five days. Of the clinical characteristics, symptom duration, facial pressure, rhinorrhea, pain, reported fever, and presumed etiology were significant predictors of antibiotic use. Of the provider characteristics, provider specialty and years in practice were significant predictors of antibiotic use. Limitations included provider bias in the manner of diagnostic coding and the fact that a study from a single institution cannot necessarily be generalized to a wider population.

Bottom line: Antibiotics continue to be overused for patients with mild acute sinusitis of short duration; nonclinical characteristics, including the individual provider, the provider’s specialty, and the presence of a medical trainee significantly influence antibiotic use.

Citation: Pynnonen MA, Lynn S, Kern HE, et al. Diagnosis and treatment of acute sinusitis in the primary care setting: a retrospective cohort. Laryngoscope. 2015;125: 2266–2272.