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Researchers found that antibiotic prescribing frequently exceeded guideline recommendations in a study of 1,000 ambulatory visits for acute sinusitis in 2024 across several locations of the Mayo Clinic health system, as published in Antimicrobial Stewardship & Healthcare Epidemiology. Although only 67.6% of the encounters met criteria for antibiotic treatment, 89.2% of encounters resulted in an antibiotic prescription. Urgent care represented one-quarter of the study’s 1,000 encounters (254 visits) and 68.5% of those urgent care encounters met antibiotic prescribing criteria—compared with 67.0% in primary care and 71.4% in emergency medicine. When it comes to guidelines overall, across all sites of care, only 49.2% of prescriptions were guideline-concordant for both antibiotic selection and treatment duration. Predictors of inappropriate antibiotic prescribing included cough (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.08–4.29; P=0.03) and symptom duration of 7–9 days (compared to <6 days; OR 7.70, 95% CI 3.24–18.31; P<0.001). The antibiotics most frequently prescribed in the study were amoxicillin/clavulanate (60.9%) or doxycycline (19.1%) for a median of 7 days. The good news is that antibiotics were prescribed in 93.5% of visits that did meet prescribing criteria.
Don’t overcompensate either: What’s also interesting is that of the 108 patients who did not receive antibiotics, 44 (40.7%) actually did meet prescribing criteria. So lack of treatment was also a miss in quite a few encounters. Of those 44 patients who were not treated, 8 (18.2%) experienced an unplanned respiratory-related encounter within 30 days.