The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
J Antimicrob Chemother. 2023 Sep 5;78(9):2217-2227. doi: 10.1093/jac/dkad227.
To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate.
All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes.
A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5-2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes.
Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.
调查普通科门诊急性鼻窦炎的并发症发生率，以及抗生素的使用是否对并发症发生率有影响。
本研究纳入了 2012 年 7 月 1 日至 2019 年 6 月 30 日期间在挪威普通科门诊被诊断为鼻窦炎的所有成年患者。挪威控制和支付健康报销数据库中的全科医生就诊数据与抗生素处方（挪威处方数据库）和住院记录（挪威患者登记处）相关联。主要结局是鼻窦炎相关的住院治疗和 30 天内的严重并发症。使用逻辑回归来评估抗生素处方、预定的危险因素、个体全科医生处方五分位数与结局之间的关联。
共确定了 415781 名患者的 711069 例急性鼻窦炎发作。在研究期间，每年的发作率（从 30.2 例/1000 人降至 21.2 例/1000 人）和抗生素处方率（从 63.3%降至 46.5%；P<0.001）均下降。每年的住院率稳定在每 10000 例鼻窦炎发作 10.0 例，严重并发症的相应发生率为 3.2%，无逐年变化（P=0.765）。抗生素的使用与住院风险增加相关[校正比值比 1.8（95%置信区间 1.5-2.1）]，但与严重并发症无关。个体全科医生处方五分位数与任何结局均无关联，而先前的药物滥用、头部受伤、颅骨手术或畸形、免疫功能低下等危险因素与两种结局的风险增加显著相关。
急性鼻窦炎的严重并发症罕见，并未发现全科医生高处方实践有保护作用。一般鼓励进一步减少抗生素的使用，除了高危人群。
