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Acute Rhinosinusitis: Prescription Patterns in a Real-World Setting
Michael S Benninger1, Chantal E Holy2, Douglas K Trask3
1The Cleveland Clinic, Cleveland, Ohio, USA benninm@ccf.org.
Objective:
Understand real-world prescription patterns for patients presenting with a first diagnosis of ARS and evaluate adherence to published medical guidelines.
Study Design:
Retrospective administrative database analysis.
Setting:
US-based outpatient settings.
Methods:
From a US claims database (MarketScan), 99,033 patients were identified with acute rhinosinusitis (ARS) in 2012 ("index"), with a complete medical and prescription history for 12 months preindex and 18 months postindex and no diagnoses of asthma or chronic rhinosinusitis. Of these, a random 10,000-patient sample was generated matched for age and sex to the initial cohort. Prescriptions and procedures at index, as well as complications up to 12 months postindex, were analyzed.
Results:
Nearly 90% of all patients received a prescription at index. Antibiotics were prescribed for 84.8% patients, followed by antitussives (16.2% for adults, 6.2% for pediatrics), nasal corticosteroids (15.5% adults, 7.5% for pediatrics), and systemic corticosteroids (10.3% for adults, 5.5% for pediatrics), with 49% adults and 29% children receiving >1 medication at first visit. Macrolides were the most frequently prescribed antibiotics (35.6% adults, 28.6% pediatrics), followed by amoxicillin/clavulanate and amoxicillin. Within 12 months of index, 3 patients presented with meningitis and 3 with orbital cellulitis.
Conclusion:
Significant variability in ARS treatment was observed, highlighting the need for heightened awareness of existing guidelines.
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