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.
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.
Authors: Randy Leung; Robert Kern; Neil Jordan; Stella Almassian; David Conley; Bruce K Tan; Rakesh Chandra Journal: Int Forum Allergy Rhinol Date: 2011-07-29 Impact factor: 3.858
Authors: Christian S Betz; Wolfgang Issing; Johannes Matschke; Anne Kremer; Eberhard Uhl; Andreas Leunig Journal: Eur Arch Otorhinolaryngol Date: 2007-08-04 Impact factor: 2.503
Authors: Wytske J Fokkens; Valerie J Lund; Joachim Mullol; Claus Bachert; Isam Alobid; Fuad Baroody; Noam Cohen; Anders Cervin; Richard Douglas; Philippe Gevaert; Christos Georgalas; Herman Goossens; Richard Harvey; Peter Hellings; Claire Hopkins; Nick Jones; Guy Joos; Livije Kalogjera; Bob Kern; Marek Kowalski; David Price; Herbert Riechelmann; Rodney Schlosser; Brent Senior; Mike Thomas; Elina Toskala; Richard Voegels; De Yun Wang; Peter John Wormald Journal: Rhinology Date: 2012-03 Impact factor: 3.681
Authors: Elisabeth H Ference; Vanessa Stubbs; Alcina K Lidder; Rakesh K Chandra; David Conley; Pedro C Avila; Annemarie G Hirsch; Jin-Young Min; Stephanie Shintani Smith; Robert C Kern; Bruce K Tan Journal: Int Forum Allergy Rhinol Date: 2015-06-16 Impact factor: 3.858
Authors: Melissa A Pynnonen; Shana Lynn; Hayley E Kern; Sarah J Novis; Sarah R Akkina; Nahid R Keshavarzi; Matthew M Davis Journal: Laryngoscope Date: 2015-05-22 Impact factor: 3.325
Authors: Rachel McKay; Allison Mah; Michael R Law; Kimberlyn McGrail; David M Patrick Journal: Antimicrob Agents Chemother Date: 2016-06-20 Impact factor: 5.191
Authors: Stephanie S Smith; Elisabeth H Ference; Charlesnika T Evans; Bruce K Tan; Robert C Kern; Rakesh K Chandra Journal: Laryngoscope Date: 2014-09-17 Impact factor: 3.325
Authors: Stephanie Shintani Smith; Charlesnika T Evans; Bruce K Tan; Rakesh K Chandra; Sean B Smith; Robert C Kern Journal: J Allergy Clin Immunol Date: 2013-08-26 Impact factor: 10.793
Authors: Amanda E Dilger; Anju T Peters; Richard G Wunderink; Bruce K Tan; Robert C Kern; David B Conley; Kevin C Welch; Jane L Holl; Stephanie Shintani Smith Journal: Am J Rhinol Allergy Date: 2018-12-03 Impact factor: 2.467
Authors: Elisabeth H Ference; Bruce K Tan; Kathryn E Hulse; Rakesh K Chandra; Sean B Smith; Robert C Kern; David B Conley; Stephanie Shintani Smith Journal: Allergy Rhinol (Providence) Date: 2015-01