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Clinicians continue to overprescribe antibiotics for sinusitis
Additional efforts are needed to develop and disseminate clinical practice guidelines
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Office visits for acute otitis media have decreased with widespread use of pneumococcal conjugate vaccine. However, visits for sinusitis have not decreased and unnecessary prescriptions continue to be written, according to a study in Pediatrics.
“Although prescriptions for amoxicillin increased in accordance with the guidelines, reducing unnecessary prescriptions for macrolides remains an important target for campaigns promoting judicious antibiotic use,” the researchers wrote.
The incidence and antibiotic treatment of AOM have changed considerably during the past 10 years, mainly as a result of the introduction of the 7-valent pneumococcal conjugate vaccine (Prevnar, Wyeth) in 2000. The widespread use of the vaccine resulted in a significant decrease in the rate of ambulatory visits attributable to AOM. In addition, use of guideline-recommended amoxicillin increased after publication of AAP practice guidelines for AOM in 2004, which reversed an earlier trend of increased use of broad-spectrum antibiotics for AOM, the researchers said.
According to the study results, the annual visit rate for acute sinusitis remained stable between 1998 and 2007 (range: 11 to 14 visits per 1,000 children; P=.67). No change occurred in the proportion of visits with receipt of an antibiotic (82%; P=.71); however, the proportion with receipt of amoxicillin increased from 19% to 58% during the study period (P<.01). Prescriptions remained common for broader-spectrum agents, especially macrolides (18% overall).
The researchers analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1998-2007). For children aged younger than 18 years with diagnosed acute sinusitis (n=538), time trends in visit rates and antibiotic prescribing were examined. Multivariate logistic regression analyses were used to identify factors associated with narrow-spectrum antibiotic prescribing.
The study researchers admitted to some limitations, but they said their findings have important implications. Acute sinusitis and AOM are considered similar diseases, but this study highlights trends in ambulatory visit rates and antibiotic treatment patterns for acute sinusitis that are different from those observed for AOM during the post-PCV7 era. These trend data provide support for continued efforts to develop and to disseminate clinical practice guidelines as a tool to optimize antibiotic prescribing practice, the researchers said.
The study was funded by the NIH.
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Disclosure: The study authors report no relevant financial disclosures.
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