A Mayo Clinic study of patients with acute sinusitis found that most received antibiotics, even when they didn’t meet antibiotic prescribing criteria, researchers reported last week in Antimicrobial Stewardship & Healthcare Epidemiology.

The retrospective study examined 1,000 randomly selected encounters for acute sinusitis at seven Mayo Clinic sites from January 1 to March 31, 2024. The aim of the study was to evaluate how often the patients met the criteria for antibiotics, the appropriateness of prescribing, and the frequency with which prescribing followed guidelines. 

Guidelines from the Infectious Diseases Society of America and the American Academy of Otolaryngology recommend antibiotics when sinusitis symptoms have persisted for 10 or more days, when symptoms are severe for three or more days, or when symptoms worsen within 10 days of initial improvement. But antibiotic prescribing for the condition remains widespread, the authors note.

“Many factors have been identified in the literature that may contribute to inappropriate prescribing, including but not limited to diagnostic uncertainty, patient expectations, and the pressure on healthcare providers to satisfy patient demands,” they wrote.

Prescribing criteria only met in 67% of encounters

Overall, antibiotic prescribing criteria were met in just 67.6% of encounters. Yet 89.2% of encounters resulted in an antibiotic prescription. An antibiotic was prescribed in 93.5% of the encounters that met prescribing criteria, and 80.2% of those that did not. Antibiotic selection and duration were guideline-concordant in roughly half (49.2%) off all encounters in which antibiotics were prescribed. 

Among encounters where prescribing criteria were not met, predictors of inappropriate prescribing included cough (odd ratio [OR], 2.15) and symptoms lasting from seven to nine days (OR, 7.70).

“These findings may aid antimicrobial stewardship programs in benchmarking and optimizing antibiotic prescribing for acute sinusitis,” the authors wrote.