A significant number of antibiotic prescriptions for acute sinusitis are written for durations of ≥10 days, while current guidelines from the Infectious Diseases Society of America (IDSA) recommend only 5 to 7 days of therapy in uncomplicated cases. The findings come from a research letter published in JAMA Internal Medicine.

Using the 2016 National Disease and Therapeutic Index (IQVIA), the researchers identified an estimated 3,696,976 physician visits in which antibiotics were prescribed for a sinusitis diagnosis. Patients with concurrent antibiotic prescriptions for other conditions and those with chronic sinusitis were excluded.

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Results showed that the median duration of therapy for all antibiotics was 10.0 days (interquartile range, 7.0–10.0 days), with 69.6% of prescriptions given for ≥10 days (95% CI, 63.7%–75.4%). After excluding azithromycin – which the IDSA explicitly recommends against using to treat sinusitis – the percentage of antibiotic courses that were ≥10 days in duration jumped to 91.5%; 7.6% (95% CI, 4.1%-11.1%) of prescriptions were for 7-day courses and just 0.5% (95% CI, 0.0%-1.6%) were for 5-day courses. Although the IDSA guidelines recommend against the use of azithromycin, 22.6% of prescriptions (95% CI, 17.2–28.0%) were for a 5-day course of azithromycin.  

The authors recognized that for patients at high risk or those who have failed initial treatment, 7 to 10 day courses of therapy may be appropriate, however they noted that it was unlikely those types of cases made up the majority of patients in the study. 

Based on their findings, the authors concluded that “the durations of most courses of antibiotic therapy for adult outpatients with sinusitis exceed guideline recommendations, which represents an opportunity to reduce the unnecessary use of antibiotics when therapy with antibiotics is indicated.”

For more information visit JAMA.com.