Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07

TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.

"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."

"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.

But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.

"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.

But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.

According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.

Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.

"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.

For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.

In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.

In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.

The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.

As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.

"It's difficult to make a distinction in a primary-care setting," Baugh
said.

http://tinyurl.com/3269q7

[
Here's a link to the JAMA paper if you want to pay for it:

http://jama.ama-assn.org/cgi/content/full/298/21/2543

I disagree that there is no way to tell if the infection is viral or
bacterial.  There is an easy way to tell:  Viral infections tend to be
self-limiting.  If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.

That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away.  Wait a good 3 or 4 weeks and
then see how it's doing.  It may start to clear by then.
]