563. Nationwide Trends in Antibiotic Selection for the Treatment of Pediatrics Acute Sinusitis, 2003-2020


 
 
 Acute sinusitis is a common diagnosis associated with outpatient antibiotic prescribing for children. Infectious Diseases Society of America guidelines (published in 2012) and American Academy of Pediatrics guidelines (published in 2013) for the management of acute sinusitis recommend amoxicillin with or without clavulanate as empiric therapy. Nationwide trends in antibiotic treatment of sinusitis have not been described since guideline publication.
 
 
 
 We evaluated trends in antibiotic prescriptions for new acute sinusitis diagnoses among commercially insured patients < 18 years old between January 1, 2003 and December 31, 2020 using the MarketScan Research Database. Subjects were identified via an outpatient encounter with an ICD code for acute sinusitis along with an oral antibiotic prescription dispensed on the day of the visit. New diagnoses were defined as having no sinusitis diagnosis in the preceding 180 days. Patients were excluded if they had a diagnosis code for chronic sinusitis or cystic fibrosis in the 6 months prior to the acute sinusitis diagnosis or had a same-day ICD code for another infection that would influence antibiotic selection (acute otitis media, cellulitis/abscess, community acquired pneumonia, Group A Streptococcal pharyngitis/tonsillitis, or urinary tract infection).
 
 
 
 3.3 million patients met the inclusion and exclusion criteria (Table 1). From 2003-2012, about 50% of patients received amoxicillin with or without clavulanate (Figure 1). Since 2013, the proportion of patients receiving first line antibiotics increased by 13%. The proportion receiving two or more antibiotics was unchanged. Approximately 80% of patients were prescribed 10-13 days of antibiotics (Figure 2). The proportion of patients receiving 14 or more days decreased by 67% over the study period.
 
 
 
 In a nationwide cohort of commercially insured children with acute sinusitis, prescriptions for amoxicillin with or without clavulanate increased after publication of society guidelines. About 40% of patients are prescribed a non-first line antibiotic or multiple antibiotics and nearly 90% of patients are prescribed 10 or more days of antibiotics, presenting important opportunities for antimicrobial stewardship interventions.
 
 
 
 Timothy J. Savage, MD, MPH, MSc, UCB: Contract to Brigham and Women's Hospital.
