Sinus Infections: Majority of Antibiotic Prescriptions Longer Than Recommended Interview with:

Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC

Dr. Fleming-Dutra

Dr. Katherine Fleming-Dutra, MD, senior author
Deputy Director
Office of Antibiotic Stewardship
CDC What is the background for this study? What are the main findings?

Response: As noted in a previous study, antibiotics are prescribed more for sinus infections than any other illness in the United States. We found that almost 70% of antibiotic prescriptions were for 10 days or longer, whereas 5-7 days is recommended for most patients when antibiotics are needed. In addition, more than 20% of antibiotic prescriptions for sinus infections were for 5 days of azithromycin, even though guidelines recommend against prescribing azithromycin for sinus infections. What should readers take away from your report? 

Response: A majority of antibiotic courses were longer than recommended for sinus infections in adults, representing an opportunity to improve antibiotic prescribing. A key antibiotic stewardship principle is to use the shortest effective length of antibiotic treatment recommended by guidelines. Improving the way healthcare professionals prescribe antibiotics, and the way patients take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that life-saving antibiotics will be available for future generations. What recommendations do you have for future research as a result of this work?

Response: Future studies are needed to determine which interventions are most effective in changing clinician behavior to prescribe the minimum effective duration of antibiotics. Additionally, in this study we were unable to examine underlying conditions or other indications for longer antibiotic courses for sinus infections. Studies with this information may improve our understanding of antibiotic prescribing practices and identify further areas for improvement. Is there anything else you would like to add?

Response: Patients should only be diagnosed with sinus infections if they meet strict diagnostic criteria as outlined in national guidelines. Also, many sinus infections will get better without antibiotics. Watchful waiting, in which the patient is watched for a few days to see if they get better before deciding whether antibiotics are needed, is a recommended treatment strategy for sinus infections that can reduce unnecessary antibiotic use.

Clinicians should follow guidelines to use antibiotics only when needed and when needed use the right antibiotic for the minimum effective duration. CDC recommends that clinicians implement antibiotic stewardship, which is the effort to measure and improve antibiotic use. CDC’s Core Elements of Outpatient Antibiotic Stewardship provide a framework for how clinicians can implement antibiotic stewardship in their outpatient practices.

Disclosure: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Core Elements of Outpatient Antibiotic Stewardship: 


King LM, Sanchez GV, Bartoces M, Hicks LA, Fleming-Dutra KE. Antibiotic Therapy Duration in US Adults With Sinusitis. JAMA Intern Med. Published online March 26, 2018. doi:10.1001/jamainternmed.2018.0407 

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