Antibiotics Mostly Useless for Sinusitis
12.18.06, 12:00 AM ET

MONDAY, Dec. 18 (HealthDay News) -- If you develop a mild sinus
infection this winter -- or even a moderately severe one -- antibiotics
won't necessarily speed your recovery, new research shows.

"In the vast majority of cases, rhinosinusitis is a self-limiting
disease," said Dr. An De Sutter, of Ghent University Hospital in
Belgium. "It can last 10 days or longer, but antibiotics do not
influence the course of the disease."

So, if you don't have signs of complications or severe infection, such
as a high fever or extreme pain, your best bet is to forgo antibiotics,
rely on symptomatic treatments and wait for a natural recovery, De
Sutter said.

De Sutter estimates that 50 percent to 70 percent of sinusitis patients
are prescribed antibiotics. Although the drugs can effectively treat
patients who develop bacterial sinusitis, they are ineffective against
viral sinusitis, which represents the majority of cases.

In the study, De Sutter and her colleagues looked at 300 patients with
mild to moderately severe sinusitis, 218 of whom received sinus X-rays.
They randomly assigned patients to receive either amoxicillin or a
placebo, asked them to keep a symptom diary and observed them for 15 days.

The researchers found that neither typical sinusitis signs and symptoms
nor abnormal X-rays had any value in predicting the course of the
disease. They also found that the disease lasted as long in patients
taking amoxicillin as it did in patients taking a placebo, and that 247
of the patients recovered within 15 days.

Only two subjective complaints -- a general feeling of illness and
reduced productivity -- predicted a slower recovery from sinusitis. "In
patients who feel ill or who do not feel able to work, recovery will
take a few days longer," De Sutter said. "But antibiotic treatment does
not speed recovery in these patients."

"We don't know for sure why antibiotic treatment seemed to have no
effect on the duration of the illness," De Sutter said. "But there two
possible explanations: Either the illness and X-ray abnormalities were
not caused by a bacterial infection, or if they were, the patients'
immune systems were able to overcome the infection just as quickly
without antibiotics."

The results of the study are published in the November/December issue of
the Annals of Family Medicine.

"We advise antibiotic treatment only when patients have severe symptoms
such as high fever and bad pain or if they have impaired immune
function," De Sutter said. "This is a very small minority of patients.
For all others, we advise 'watchful waiting.' "

Instead of prescribing antibiotics, doctors should focus on symptom
relief: paracetamol for pain relief and intranasal decongestants in case
of a blocked nose, De Sutter suggested. "Some patients experience
subjective relief by inhaling hot steam," she added.

In a similar study in the same journal, researchers found the desire for
pain relief was one of the main reasons why sore-throat patients demand
antibiotics. They concluded that it may be preferable to treat such
patients with pain medications instead of antibiotics.

In most sinusitis cases, De Sutter believes that doctors should resist
patient demand for antibiotics. "Doctors should explain to patients that
antibiotics do not make a difference in the speed of recovery and can
cause side effects," De Sutter said. "In our trial, diarrhea was more
frequent with antibiotics. Other known side effects include nausea, oral
or vaginal mold or yeast infection, allergic reactions and colitis."

The over-prescription of antibiotics, especially in children, also can
cause the upper respiratory tract to become colonized with
antibiotic-resistant bacteria such as S. pneumoniae, De Sutter said.
"These resistant bacteria may cause infections that are more difficult
to treat and may be passed on to other people."

"This is an interesting study because it looked at a large population of
people with acute sinusitis," said Dr. David Sherris, chairman of
otolaryngology at the University at Buffalo in New York.

"Most people do not need antibiotic therapy unless symptoms persist for
more than seven to 10 days," Sherris said. "Plain X-rays of the sinuses
add little or nothing to the diagnosis and treatment of acute sinusitis."

But that doesn't mean that imaging is of no value in sinusitis cases, he
added. With prolonged or recurrent sinusitis or complications, computed
tomography (CT) is the test of choice and works well, he noted.

"Early referral to an otolaryngologist is indicated in the most severe
cases or where symptoms are out of proportion with findings," Sherris
said. "The specialist can perform nasal endoscopy and accurately assess
the most subtle CT scan findings."

Although the new study confirms some observations that Sherris has made
during years of clinical practice, it would have been stronger if it had
used the symptom system from the American Academy of Otolaryngology Head
and Neck Surgery, Sherris said. "It is more complete than the one
presented in this article, and though not infallible, is better to
diagnose acute sinusitis."

Sherris also faulted the researchers' choice of antibiotics.
"Amoxicillin, unless used in very high doses, is not a good first line
antibiotic in acute sinusitis," he said. "Amoxicillin-clavulanate
[augmentin] is a better choice, and is now generic in the United States.
If there is an allergy to penicillin, physicians should consider
azithromycin or a respiratory quinolone."

More information

For more on rhinitis, head to the U.S. Centers for Disease Control and
Prevention.

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