Abstract
Objective: Recent studies confirm that antibiotics are unnecessary for the vast majority of acute rhinosinusitis (ARS) cases. Guidelines advocate watchful waiting for mild-moderate ARS, with initiation of antibiotics and inhaled nasal steroids (INS) if symptoms do not improve. This study assesses treatment for ARS by otolaryngologists on a national level.
Method: Ambulatory visits to otolaryngologists for ARS were extracted from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Care Survey (NHAMCS) for 2006-2009. This survey is conducted annually by the US Department of Health and Human Services. Descriptive statistics were calculated to determine utilization of antibiotics and INS.
Results: Among an estimated 19.8 million adult visits for ARS, 955,000 visits were to otolaryngologists (mean age, 47.8 ± 2.5 years; 60.0 ± 7.1% female). Otolaryngologists prescribed intranasal steroids in 24.9 ± 6.2% of visits. Antibiotics were prescribed in 57.0 ± 6.5% of ARS visits to otolaryngologists, and 93.0 ± 4.6% of these prescriptions were for broad-spectrum antibiotics (amoxicillin-clavulanate, second/third generation cephalosporins, azithromycin, clarithromycin, or quinolones).
Conclusion: Otolaryngologists widely prescribe antibiotics for ARS, though current data suggest that the majority of ARS cases resolve without antibiotics. High rates of antibiotic prescribing, often with broad spectrum coverage, and relative scarcity of INS utilization suggest opportunities to improve prescribing patterns.
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