Outpatient Acute Sinusitis: Antibiotic Prescribing Patterns Vary by Specialty

In treating outpatient acute rhinosinusitis, how frequently do otolaryngologists vs other clinicians prescribe amoxicillin-clavulanate, the first-line treatment?

Amoxicillin-clavulanate is prescribed more frequently by otolaryngologists than by non-otolaryngologists; moreover, otolaryngologists adhere more to current national guidelines for acute bacterial rhinosinusitis (ABRS) first-line therapy than non-otolaryngologists, according to study findings presented at the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) 2022 Annual Meeting and OTO Experience, held in Philadelphia, Pennsylvania, September 10 to 14, 2022.

More than 20% of antibiotics prescribed in adults in the US annually are for ABRS, which is among the most common outpatient diagnoses nationally. Researchers sought to measure the prescription frequency of amoxicillin-clavulanate, the preferred first-line therapy for ABRS according to the International Consensus in Allergy and Rhinology 2021 and American Academy of Otolaryngology-Head and Neck Surgery 2015 guidelines, and to compare otolaryngologists with non-otolaryngologists for differences in prescription actions for outpatients with ABRS.

The investigators conducted an analysis of weighted patient data collected by the National Ambulatory Medical Care Survey from 2007 to 2016 of adults diagnosed with acute sinusitis from to determine visit rates, antibiotic prescription trends, and differences in prescription behaviors between otolaryngologists and non-otolaryngologists. Data from patients with concomitant diagnoses requiring antibiotics and visits with multiple prescribed antibiotics were excluded from the analysis.

Researchers found that from 2007 to 2016, acute sinusitis was diagnosed in 0.7% of all outpatient visits (95% CI, 0.6-0.8%) and the greatest increase in prescription frequency during that time was amoxicillin-clavulanate (11.59%). They noted the most common alternative prescription for otolaryngologists was cephalosporins (18.07%) and for non-otolaryngologists the most common alternative prescription was macrolides (30.13%).

The researchers found that amoxicillin-clavulanate was more commonly prescribed among otolaryngologists (31.59%) vs non-otolaryngologists (18.41%; P <.001). Prescribing amoxicillin only was more common among non-otolaryngologists (42.97%) vs otolaryngologists (6.42%; P <.001). Not prescribing any antibiotics was more common among otolaryngologists (30.59%) vs non-otolaryngologists (18.48%; P <.001).

Researchers concluded that “Otolaryngologists favor amoxicillin-clavulanate and adhere to current national guidelines for ABRS first-line therapy greater than non-otolaryngologists.” They added that “Interventions to further improve antibiotic prescription behaviors in accordance with national guidelines are needed.”


Jin V, Patel MJ, Chiu R, Perez BR, Zhu AQ, Lee VS. Trends and frequencies of national antibiotic prescriptions for acute sinusitis outpatient visits in adults. Otolaryngol Head Neck Surg. 2022;167(1 suppl):P151.