More than one in five antibiotic (abx) prescriptions for adults are for sinusitis. Published guidelines discourage the use of abx therapy for presumed viral infections, including most cases of acute sinusitis (AS), but providers may have difficulty ruling out bacterial infection. Due to the high potential for inappropriate abx use in the management of AS, we conducted a review of abx prescribing practices in our VA facility to evaluate concordance with the Infectious Diseases Society of America (IDSA) clinical practice guidelines.
Retrospective chart review was conducted of a random sample of clinic visits with a primary diagnosis of AS during the 1 year period beginning in October 2013. The following charts were excluded from analysis: available culture and susceptibility (C&S) data; concurrent infection; earlier visit for respiratory infection during the study period. Abx orders were assessed for concordance based on agent, dosage, frequency, and duration. Descriptive statistics were used to profile the study sample.
864 visits for AS were identified. Of a random sample of 175 charts, 59 were excluded due to co-infection (26), previous visits (14), existing C&S data (8), or other reasons (11). The mean patient age was 54, and most were male (78%) and white (65%). Penicillin allergy was documented in 14%. Concordance with indication for abx occurred in 38% of cases. Of 80 patients in which abx was not indicated, 71 (89%) received abx. Of cases where an abx was indicated, 19 (54%) received an inappropriate agent. Of those that received an appropriate agent, 31% received too low a dose, and 63% received an inappropriate duration of abx.
Despite evidence based practice guidelines for the use of abx in patients with AS, inappropriate prescribing is a significant challenge in our facility. When aggregated across abx type, frequency and duration, overall concordance with IDSA guidelines was only 14%. Even when abx therapy was indicated and prescribed, dose and duration were problematic. Provider education and implementation of a clinical decision support tool may help to reduce inappropriate abx prescribing for AS in our facility.
D. Rehman, None
A. Garrett, None
J. C. Thompson, None
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