Periprocedural management of the patient with diabetes mellitus undergoing coronary angiography: current practice.

is diagnosed based on physical examination findings and symptoms,datanotcapturedinNAMCS/NHAMCS,wewere unable to determine which patients had acute bacterial sinusitis as strictly defined based on the criteria suggested by recent clinical guidelines. We were also not able to determine ifpatients receivingantibiotic treatmenthadrecurrent sinusitis or had previously experienced treatment failurewithnarrow-spectrumtherapyforsinusitis,eitherofwhich mighthavemadeprescriptionofabroad-spectrumagentacceptable.Previousstudieshavesuggested,however, thatbacterial sinusitis composes a relatively small fraction of acute sinusitis cases seen in primary care, and treatment failure isalsouncommon.Wewerealsounabletodeterminewhich patients had an allergy to recommended agents. This study highlights that prescribing of broadspectrum antibiotics for sinusitis, especially quinolones and macrolides, is extremely common. This is an important target for antimicrobial stewardship efforts partially because the benefits of antibiotic therapy are limited. Qualitative research to explore the health care provider and patient attitudes that influence antibiotic selection is a next step to understanding the problem. Also critically important are adoption of clinical guidelines that promote appropriate antibiotic use. Changes in prescribing behavior of health care providers for sinusitis are urgently needed to improve health care quality and stem the rising tide of antibiotic resistance in the United States.