Mayo Clinic study identified Over prescription of Antibiotics for Acute Sinusitis

A new study published in the journal of Antimicrobial Stewardship & Healthcare Epidemiology found that most patients with acute sinusitis received antibiotics, even when they did not meet established prescribing criteria. This research evaluated how often patients met criteria for antibiotic therapy, the appropriateness of antibiotic prescribing, and adherence to clinical guidelines. The findings suggest substantial overuse of antibiotics in the management of acute sinusitis and highlight the need for improved adherence to evidence-based prescribing practices

This study reviewed 1,000 randomly selected adult outpatient encounters for acute sinusitis that occurred between January 1 and March 31, 2024. Each medical record was assessed to determine whether patients met nationally accepted clinical criteria for antibiotic therapy, as well as whether the prescribed antibiotic and treatment duration aligned with local guideline recommendations.

The analysis revealed that only 67.6% of patient encounters met the recommended criteria for antibiotic prescribing. However, antibiotics were prescribed in 93.5% of these guideline-eligible cases and, notably, in 80.2% of encounters where patients did not meet the criteria. The findings indicate that a substantial proportion of antibiotic prescriptions may have been unnecessary, potentially contributing to antimicrobial resistance and avoidable medication exposure.

This research examined the quality of prescribing practices beyond the decision to prescribe. They found that both the choice of antibiotic and the duration of therapy were consistent with guideline recommendations in only 49.2% of all encounters. This suggests that opportunities exist not only to reduce unnecessary antibiotic use but also to improve adherence to recommended treatment regimens when antibiotics are indicated.

To better understand factors associated with inappropriate prescribing, this multivariable logistic regression analysis was conducted. Patients presenting with a cough were more than twice as likely to receive antibiotics inappropriately when compared to those without a cough. Likewise, individuals reporting symptoms lasting between seven and nine days had significantly higher odds of receiving antibiotics unnecessarily than those with symptoms lasting fewer than 6 days, despite guideline recommendations that emphasize more specific clinical criteria before initiating treatment.

The study also identified differences based on the type of healthcare encounter. Electronic or virtual consultations were associated with substantially lower odds of antibiotic prescribing than traditional in-person visits, suggesting that telemedicine encounters may encourage more conservative prescribing practices for acute sinusitis.

Source:

Arensman Hannan, K., Ilges, D., Le, K. T., Cole, K., Stevens, R. W., & Jensen, K. (2026). Ambulatory antibiotic prescribing for acute sinusitis: a multicenter, retrospective cohort study evaluating appropriateness. Antimicrobial Stewardship & Healthcare Epidemiology, 6(1), e193. https://doi.org/10.1017/ash.2026.10743