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Medical Forum / Diseases and Disorders / Sinusitis / February 2005Are antibiotics beneficial for patients with sinusitis complaints? A randomized double-blind clinical trial
Are antibiotics beneficial for patients with sinusitis complaints? A randomized double-blind clinical trial. Merenstein D, Whittaker C, Chadwell T, Wegner B, D'Amico F. The Johns Hopkins Hospital, 600 North Wolfe St., Carnegie 291, Baltimore, MD 21287-6220 USA. E-mail: dmerenstein@jhu.edu. BACKGROUND: Sinusitis is the fifth most common reason for patients to visit primary care physicians, yet clinical outcomes relevant to patients are seldom studied. OBJECTIVE: To determine whether patients with purulent rhinitis, "sinusitis-type symptoms," improved with antibiotics. Second, to examine a clinical prediction rule to provide preliminary validation data. METHODS: Prospective clinical trial, with double-blinded placebo controlled randomization. The setting was a suburb of Washington, DC, from Oct 1, 2001, to March 31, 2003. All participants were 18 years or older, presenting to a family practice clinic with a complaint of sinusitis and with pus in the nasal cavity, facial pressure, or nasal discharge lasting longer than 7 days. The main outcome measures were resolution of symptoms within a 14-day follow-up period and the time to improvement (days). RESULTS: After exclusion criteria, 135 patients were randomized to either placebo (n=68) or amoxicillin (n=67) for 10 days. Intention-to-treat analyses showed that 32 (48%) of the amoxicillin group vs 25 (37%) of the placebo group (P=.26) showed complete improvement by the end of the 2-week follow-up period (relative risk=1.3; 95% confidence interval [CI], 0.87-1.94]). Although the rates of improvement were not statistically significantly different at the end of 2 weeks, the amoxicillin group improved significantly earlier, in the course of treatment, a median of 8 vs 12 days, than did the placebo group (P=.039). CONCLUSION: For most patients with sinusitis-type complaints, no improvement was seen with anti-biotics over placebo. For those who did improve, data suggested there is a subgroup of patients who may benefit from antibiotics. PMID: 15689289 [PubMed - in process] On 2/8/05 11:40 AM, in article 1107891655.770851.86680@l41g2000cwc.googlegroups.com, "Woody Long" <woodylong30@hotmail.com> wrote: > Are antibiotics beneficial for patients with sinusitis complaints? A > randomized double-blind clinical trial. [quoted text clipped - 32 lines] > > PMID: 15689289 [PubMed - in process] There have been other studies too. In Lancet, 84% with antibiotic were improved, and 76% on placebo improved. Bueler showed that on the 6th day, the symptoms of antibiotic and placebo group were identical. On the other hand, the correct course of antibiotic can reverse a chronic sinusitis. > On 2/8/05 11:40 AM, in article > 1107891655.770851.86680@l41g2000cwc.googlegroups.com, "Woody Long" [quoted text clipped - 41 lines] > Bueler showed that on the 6th day, the symptoms of antibiotic and placebo > group were identical. What I would like to see is a study that compares antibiotic alone versus irrigation (e.g. Hydropulse) alone, for acute sinusitis.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. My MD will not give me an antibiotic unless I complain of yellow flem or infection. He will give me Clarinex, a nose spray or use a saline spray and self helps to do. shirley On 2/10/05 2:53 AM, in article 29524-420B3D2A-87@storefull-3132.bay.webtv.net, "Shirley Thebaglady" <thebagladyshirleyann@webtv.net> wrote: > My MD will not give me an antibiotic unless I complain of yellow flem or > infection. [quoted text clipped - 3 lines] > > shirley Considering the evidence that the more antibiotic, the more breast cancer, serious urinary infections, asthma and considering that studies have shown similar results with placebo, it sounds like your doctor is concerned about your health. > My MD will not give me an antibiotic unless I complain of yellow flem or > infection. Unfortunately, I've had yellow phlegm since my chronic sinusitis started in 1997. Two surgeries and dozens of courses of antibiotics later, I still cough up little bits of yellow phlegm on a daily basis. And if I catch a cold, I get a flood of brown phlegm. Other folks just get a runny nose when they get a cold. With me I immediately get a flood of thick brown phlegm. My ENTs have pretty much given up on me. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >Unfortunately, I've had yellow phlegm since my chronic sinusitis started >in 1997. Two surgeries and dozens of courses of antibiotics later, I [quoted text clipped - 4 lines] > >My ENTs have pretty much given up on me. I would suggest either or both of (1) Go to Mayo to explore the possibility of some systemic condition that impairs ability to recover from infections. They are extremely thorough. or (2) Go to U.Penn. or a doctor who uses the Kennedy approach of removing a lot of the ethmoid bone to stop chronic sinus infections. > What I would like to see is a study that compares antibiotic alone versus irrigation (e.g. Hydropulse) alone, for acute sinusitis. I don't know about a study but I can give you my very current personal experience. Short and direct: Miserable progressive sinus irritation, constant drainage and swelling for literally years. Swelling in the face, fatigue, feels like poison ivy in my nose. Irrigation every day (water pik), allegra, sudafed, rhinocort etc. - Nothing Levaquin - Wow, clears up within 2 days! Keep irrigating every day. Feel great. Finish Levaquin, keep irrigating, within 10 days comes back, miserable again. Try Augmentin, doesn't work very well, keep irrigating, still miserable. Wait 3 weeks, still miserable, keep irrigating. Levaquin again - clears up in 2 days! Currently still taking it. Levaquin is $10 a pill, I can't take this stuff forever. Conclusion, irrigation is helpful but not a magic cureall or preventative. Frankly, I'm getting desperate enough to irrigate with Clorox! Not really, but I can't much more of this. On 2/10/05 7:38 PM, in article ZqmdnSB6EIsutZHfRVn_vQ@giganews.com, "Ron" <NoSpam@SpamStopper.Org> wrote: >> What I would like to see is a study that compares antibiotic alone versus >> irrigation (e.g. Hydropulse) alone, for acute sinusitis. [quoted text clipped - 18 lines] > Frankly, I'm getting desperate enough to irrigate with Clorox! Not really, > but I can't much more of this. Irrigation can only stimulate cilia movement and remove thick mucus and bacteria. If you have no cilia and if the sinuses are completely blocked so that infection is within the sinus with no outlet, then treatment other than irrigation is indicated. Fortunaltely for many patients, this can make a difference. hydromed@adelphia.net (Murray Grossan) wrote: >Irrigation can only stimulate cilia movement > and remove thick mucus and bacteria. If you [quoted text clipped - 5 lines] >Fortunaltely for many patients, this can make > a difference. A few months ago, I had an acute flair-up. ...Rather than go for another load of antibiotics, I decided to try just the irrigation. ..After a little more than a week, I was back to my usual "chronic" state. ...I know if I would have taken a course of levaquin, I would have lost the symptoms quicker, but the base condition would either still be there (simmering), or else return to this state, shortly thereafter. The irrigation helped, not in the respect of eliminating the sinusitis, but rather towards facilitating the natural drainage. In the end, it was my own immune system that quashed the flair-up. I am sure that had I not used the irrigation, I would have been considerably sicker. The problem with a lot of these antibiotic/placebo tests is, there are no end of people ready, able, and willing to race to the Dr. for an antibiotic at the first sign of a plugged nose. ...And it's funny, as dumb as some people are with regards to medical problems and terminology, they all know the word: "antibiotics." ...I only hope that all Drs. prescribe the run-of-the-mill antibiotics for these (hypochondriac) people, and save the few effective ones left for those with a legitimate disease. ....Jon On 2/14/05 9:19 AM, in article 28254-4210DDA5-261@storefull-3254.bay.webtv.net, "Johnny1000@webtv.net" > ...I only hope > that all Drs. prescribe the run-of-the-mill antibiotics for these > (hypochondriac) people, and save the few effective ones left for those > with a legitimate disease. ....Jon Unfortunately, the more antibiotics, the more resistant organisms may develop plus the other problems with excess antibiotic including resistant urinary infections. Join ZAAP . Zaap antibiotic abuse personally. Tell your friends and family about avoiding unnecessary antibiotics. Don't force the doctor to give you an antibiotic. It takes a doctor 1.5 minutes to write an antibiotic. It takes 20 + minutes to try to convince a patient not to take an antibiotic. You personally can help by telling your friends about this. > Unfortunately, the more antibiotics, the more resistant organisms may > develop plus the other problems with excess antibiotic including resistant [quoted text clipped - 6 lines] > to try to convince a patient not to take an antibiotic. > You personally can help by telling your friends about this. I would like to not have to take antibiotics but after months of irragating, it just got a worse. Not that irrigating wasn't helpful. It feels good and does provide some relief for a few hours at best. But antibiotics clear up the condition. Then when the medicine runs out it comes back. So what am I supposed to do? > I would like to not have to take antibiotics but after months of irragating, it > just got a worse. Not that irrigating wasn't helpful. It feels good and does provide > some relief for a few hours at best. But antibiotics clear up the condition. Then > when the medicine runs out it comes back. So what am I supposed to do? The anitbiotic is most likely just treating a secondary bacterial infection rather than the underlying pathology which is why you feel better on it, and relapse when you stop. Most patients think they have simply undertreated the infection and need more antibiotic for a longer period to knock out the sinusitis permanently, but this is incorrect. The reason to stop taking the antibiotic is that the antibiotic actually makes the underlying pathology worse over time. Woody |
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