title: Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings.
abstract: OBJECTIVE
  To identify variations in antibiotic treatment of acute rhinosinusitis (ARS) on a national level.
  
  
  METHODS
  Cross-sectional study of a national database.
  
  
  METHODS
  Otolaryngology and primary care ambulatory settings.
  
  
  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).
  
  
  CONCLUSIONS
  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: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. shintani@northwestern.edu
authors: Stephanie Shintani
authors: SS
authors: Smith
authors: Robert C
authors: RC
authors: Kern
authors: Rakesh K
authors: RK
authors: Chandra
authors: Bruce K
authors: BK
authors: Tan
authors: Charlesnika T
authors: CT
authors: Evans
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents