The use of fluoroquinolones and macrolides for sinusitis: a retrospective cross-sectional study
Background and objective
β-Lactam antibiotics are the recommended first-line treatment for acute bacterial sinusitis. Fluoroquinolones are recommended in patients with hypersensitivity reactions to penicillins, and macrolide antibiotics are no longer recommended. The objectives of this study were to understand whether outpatient antibiotic prescribing practices adhere to treatment guidelines and to describe rates of fluoroquinolone and macrolide antibiotic prescribing for the treatment of sinusitis.
This was a retrospective cross-sectional study using US National Ambulatory Medical Care Survey (NAMCS) data. The prevalence of antibiotic prescribing for sinusitis was estimated, and the antibiotic prescribing pattern was measured. Additionally, significant factors associated with various antibiotic prescribing during the visits related to sinusitis were identified.
Among physician visits related to sinusitis from 2013 to 2016 (n = 2739), 66.4% involved antibiotic prescribing. Visits with antibiotic prescribing showed greater proportions of patients aged < 18 years (21.7 vs 11.1%, p < 0.001), patients reporting fever (79.8 vs 50.7%, p < 0.001), and patients seeing family physicians or internal medicine specialists (68.4 vs 44.8%, p < 0.001) than those without antibiotic prescribing. Penicillins, macrolides, cephalosporins, and fluoroquinolones were prescribed in 42.2%, 30.6%, 15.2%, and 9.5% of the visits involving antibiotic prescribing for sinusitis, respectively. The odds of fluoroquinolone/macrolide prescribing were reduced by 73% if patients visited pediatricians and by 59% with otolaryngologists.
Macrolides were the most common inappropriate antibiotic class prescribed for sinusitis. This study identifies a need for more focused attention to improve prescribing for sinusitis and adherence to the treatment guidelines.
Compliance with Ethical Standards
No source of funding was used for this study.
Conflicts of Interest
The authors have no conflicts of interest that are directly relevant to the content of this article.
- 1.Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. 2013. http://www.cdc.gov/drugresistance/threat-report-2013/. Accessed 19 Nov 2017.
- 2.Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. https://www.cdc.gov/antibiotic-use/healthcare/ implementation/core-elements.html. Accessed 19 Nov 2017.
- 3.The Joint Commission. Antimicrobial stewardship. https://www.jointcommission.org/antimicrobial_stewardship_faqs/. Accessed 19 Nov 2017.
- 4.Centers for Disease Control and Prevention. Antibiotic use in the United States, 2017: Progress and opportunities. US Department of Health and Human Services, CDC. 2017. https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report.pdf. Accessed 19 Nov 2017.
- 10.Rosenfeld R, Piccirillo J, Chandrasekhar S, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1–39.Google Scholar
- 19.U.S. Food & Drug Administration. FDA drug safety communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. https://www.fda.gov/Drugs/DrugSafety/ucm511530.htm. Accessed 19 Nov 2017.
- 20.U.S. Food & Drug Administration. FDA drug safety communication: FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. https://www.fda.gov/Drugs/DrugSafety/ucm611032.htm/ Accessed 30 July 2018.