Don't Prescribe Antibiotics for Adult Sinus Woes

THURSDAY, March 13 (HealthDay News) -- It's extremely difficult for doctors to tell the difference between sinus infections that can be cured by antibiotics and those that can't, a new review finds.

Given the growing problem of antibiotic resistance, the study authors urge that physicians give up using antibiotics altogether for adult patients with rhinosinusitis -- even when symptoms persist beyond a week.

"Antibiotics offer little benefit for patients with acute rhinosinusitis-like complaints," wrote the research team led by Dr. Jim Young of University Hospital Basel, Switzerland. "Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days," they added in the March 15 issue ofThe Lancet.

The European group noted that upper respiratory tract infections are responsible for a full third of doctor's appointments in the United States, and a third of those visits end in a diagnosis of rhinosinusitis. Currently, about 80 percent of patients receive a prescription for an antibiotic.

Antibiotics are only useful against bacterial disease -- they do not fight viral infections. But how good are doctors at distinguishing between the two in the typical clinical setting?

To find out, Young's group looked at data from nine trials with a total of more than 2,500 adult patients with rhinosinusitis. Doctors in the trials used a patient's medical history or symptoms -- for example, facial pain, pus-filled nasal discharge, or a prior cold -- that have been thought helpful in distinguishing a bacterial infection from a viral one.

Unfortunately, even these symptoms failed to help doctors determine whether antibiotics were appropriate. In fact, the analysis found that 15 patients with rhinosinusitis-like complaints had to be given antibiotics before one additional patient benefited from treatment, meaning that the other 14 were getting the drugs for no real purpose, the authors wrote. The result didn't change, regardless of patient age or duration or severity of symptoms.

The findings only apply to adult patients because children were not included in the study, the researchers stressed.

However, one otolaryngologist said the study goes too far in banning antibiotics for adult cases.

"This study should not convey the message that antibiotics are not indicated for all patients with sinusitis," Dr. Jordan S. Josephson, of Lenox Hill Hospital in New York City, said in a statement. He believes that while the drugs are certainly ineffective against viral sinusitis, they can offer patients with acute bacterial infections "significant symptom relief and improvement."

Josephson notes the study does not address "the 30-plus million Americans that suffer from chronic sinusitis." He said the evidence is clear that many patients with these longer-term sinus problems do benefit from antibiotic therapy.

However, the new findings mirror those of a study published last March in theArchives of Otolaryngology Head and Neck Surgery. That study found that U.S. doctors are consistently overprescribing antibiotics for sinus infections.