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The use of fluoroquinolones and macrolides for sinusitis: a retrospective cross-sectional study

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Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Presbyterian College School of Pharmacy, 307 N. Broad St, Clinton, SC, 29325, USA

    Amber B. Giles & Kayce M. Shealy

  2. Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, 307 N Broad St, Clinton, 29325, SC, USA

    Jun Wu

Authors
  1. Amber B. Giles
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Correspondence to Jun Wu.

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No source of funding was used for this study.

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The authors have no conflicts of interest that are directly relevant to the content of this article.

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Giles, A.B., Wu, J. & Shealy, K.M. The use of fluoroquinolones and macrolides for sinusitis: a retrospective cross-sectional study. Drugs Ther Perspect 35, 518–526 (2019). https://doi.org/10.1007/s40267-019-00652-6

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