CDC Study Says Sinus Infections Are Treated With Antibiotics Longer Than Necessary

A CDC study published in JAMA Internal Medicine on Monday found that primary care providers are prescribing antibiotics for sinus infections longer than recommended by clinical practice guidelines.

A key antibiotic stewardship principle is to use the shortest effective length of antibiotics recommended by guidelines in order to fight the growing problem of antibiotic resistance. In the report, the CDC said that antibiotic stewardship programs can ensure that treatment adheres to these guidelines.

According to the CDC, at least 2 million people become infected with bacteria that are resistant to antibiotics each year. Additionally, at least 23,000 people die as a direct result of these infections, and many more die from other conditions that were complicated by an antibiotic-resistant infection. Last year, The Joint Commission put in place an antimicrobial stewardship standard for institutions to follow.

Antibiotics are prescribed more for sinus infections than for any other illness. The CDC study focused on an estimated 3.7 million visits (95% CI, 3,124,279-4,269,673) at which antibiotic therapy was prescribed for sinusitis that met the study criteria. More than two-thirds (69.6%) of antibiotic prescriptions, and 91.5% of non-azithromycin antibiotic prescriptions, were for 10 days or longer, even though the Infectious Diseases Society of America recommends 5 to 7 days of therapy for uncomplicated cases of sinusitis.

In addition, more than 20% of antibiotic prescriptions for sinus infections were for 5 days of azithromycin, even though guidelines recommend against prescribing azithromycin because of high rates of existing resistance to this drug and others in its class.

No penicillin or tetracycline prescriptions were for 5-day courses, and only 5% of antibiotic prescriptions were for 7-day courses of penicillins, tetracyclines, or fluoroquinolones.

According to the authors, although 7- to 10-day courses are recommended for patients at high risk or whose initial treatment has failed, it is unlikely that such cases represent the majority of patients captured in the study. They cited previous work that has shown that shorter durations (3-7 days) of antibiotics have been associated with similar outcomes and fewer drug-related adverse events compared with longer durations (6-10 days).

The study has limitations, the authors said. They were not able to account for underlying conditions or other indicators that may have called for a longer course of antibiotics. Because visits with a diagnosis of unspecified sinusitis were excluded from the analysis, some cases of acute sinusitis may have been missed. However, the findings of a sensitivity analysis that included cases of both acute and unspecified sinusitis were similar.

Reference

King LM, Sanchez GV, Bartoces M, Hicks LA, Fleming-Dutra KE. Antibiotic therapy duration in US adults with sinusitis [published online March 26, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.0407.