“I'm Calling It Sinusitis. Here's Your Antibiotic!”

Almost all upper respiratory tract infections are viral. The one exception to this generalization is sinusitis, which sometimes does have a bacterial component and, in severe cases, can benefit from empirical antibiotics. Researchers examined the records of a U.S. nationwide direct-to-consumer telemedicine service. During a 40-month period, 105 physicians treated more than 13,000 patients (mean age, 39) with upper respiratory complaints, coded as sinusitis, pharyngitis, bronchitis, influenza, or unspecified respiratory tract infection.

Physicians ranged widely in their likelihood of prescribing antibiotics for these patients: Mean antibiotic prescribing rates were 40% in the lowest quartile of prescribers and 87% in the highest. Physicians i…