Antibiotics Mostly Useless for Sinusitis

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By Rick Ansorge
HealthDay Reporter
Monday, December 18, 2006; 12:00 AM

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 theAnnals 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.


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