Feb 15 Antibiotics don't help fight most
sinus infections, although doctors routinely prescribe them for
that purpose, according to a U.S. study.
Researchers whose work was published in the Journal of the
American Medical Association found that antibiotics didn't ease
patients' symptoms or get them back to work any sooner than an
inactive placebo pill.
Antibiotics are known to fuel the evolution of
drug-resistant bacteria and experts have grown increasingly
worried about overuse.
This is a particular concern with sinus infections, because
doctors can't tell if the disease is caused by bacteria or by a
virus, in which case antibiotics are useless.
"There is not much to be gained from antibiotics," said Jane
Garbutt of Washington University School of Medicine in St.
Louis, who led the study.
"Rather than give everybody an antibiotic hoping to find the
(patients) with bacteria, our findings would suggest refraining
from antibiotics and doing what we call watchful waiting," she
told Reuters Health.
That involves keeping an eye on patients to see if they get
better, but not using drugs other than over-the-counter
People with sinus infections, also called acute sinusitis,
have lasting and severe cold-like symptoms such as a runny nose
and pain around the eyes, nose or forehead.
"It's the fifth most common reason antibiotics are
prescribed for adults. It's hard for doctors not to give an
antibiotic because patients are so miserable, and we don't have
anything else to give them," said Garbutt.
Garbutt and her colleagues used official U.S. guidelines to
identify patients with sinus infections. They randomly assigned
166 adults to either placebo pills or a 10-day treatment with
the antibiotic amoxicillin.
Based on patient ratings on a symptom scale known as the
modified Sinonasal Outcome Test-16, or SNOT-16, the researchers
found little difference between the two patient groups.
Using the scale, where 0 equals "no problem" and 3 a "severe
problem," the antibiotic group rated their symptoms at 1.12
after three days, while the placebo group averaged 1.14.
After seven days, there were signs of benefit from the
antibiotic, but the effect was small and had vanished another
three days later.
After 10 days, 78 percent of the people on antibiotics and
80 percent of the placebo-treated people said they felt a lot
better or no longer had symptoms.
Fewer than two percent of sinus infections are bacterial,
said Anthony Chow, an expert in infectious diseases at the
University of British Columbia in Vancouver, Canada.
"Most cases are viral, and the vast majority don't require
antibiotics," he said.
"Antibiotics have been abused, so there is a need to be more
cautious in prescribing them and to hold back."
But he said that antibiotics still do have a place and
recently chaired a committee at the Infectious Diseases Society,
which has developed guidelines to help spot infections that are
more likely to be bacterial.
Those guidelines, still in press, recommend treating only
patients whose symptoms last for at least 10 days and keep
worsening, who are severely sick with high fever and other
symptoms, or who improve and then get worse again.
(Reporting from New York by Frederik Joelving at Reuters
Health; editing by Elaine Lies and Bob Tourtellotte)