• Stephanie Shintani Smith, Anne Caliendo, Brian T Cheng, Robert C Kern, Jane Holl, Jeffrey A Linder, and Kenzie A Cameron.
• Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. s-shintani@northwestern.edu.
• J Gen Intern Med. 2023 Feb 1; 38 (3): 683690683-690.

BackgroundAntibiotics are prescribed in >80% of outpatient acute rhinosinusitis (ARS) visits, despite the low incidence of bacterial infection. Previous studies have shown patient expectations are the most robust predictor of antibiotics prescription in ARS. However, patient perceptions are not well known or understood.ObjectiveTo understand patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotic treatment of ARS.DesignIterative thematic analysis of semi-structured interviews.ParticipantsNineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL.Main MeasuresPerceptions of patients with ARS.Key ResultsWe interviewed 19 patients, identifying the following drivers of antibiotic use: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. For deterrents, the following themes emerged: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. Patients identified that a trustworthy physician's recommendation for antibiotics was a driver, and a recommendation against antibiotics was a deterrent to taking antibiotics; a delayed antibiotic prescription also served as a deterrent. Antibiotic side effects were viewed neutrally by most participants, though they were a deterrent to some.ConclusionsPatients have misconceptions about the indications and effectiveness of antibiotics for ARS. Intimate knowledge of key antibiotic drivers and deterrents, from the perspective of patients with ARS, can be leveraged to engage and increase patients' knowledge, and set appropriate expectations for antibiotics for ARS.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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