Sinus Infection? Antibiotics No Help
Antibiotics, Steroid Spray No Help for Adult Sinus Infections
By
Daniel J. DeNoon
WebMD Health News
Reviewed By
Louise Chang, MD
Dec. 4, 2007 -- Neither antibiotics nor steroid sprays offer much help to
adults with sinus infections, a British study shows.
One of the most common complications of the common
cold or flu is a sinus infection. The symptoms: a stuffy nose; a thick, dark-colored nasal
discharge; and head pain.
You've very likely had such an infection. And if, like 25 million other
Americans, you went to a U.S. doctor, there's a 90% chance you got a
prescription for antibiotics.
You very likely had some side effects from that antibiotic. But it's
extremely unlikely the antibiotics you took were much help, according to a
study by Ian G. Williamson, MD, senior lecturer at the University of
Southampton, England.
"We are confident that if there is an effect of antibiotics on acute
sinus infections, it is not very big -- certainly not as big as people have
been led to believe," Williamson tells WebMD.
Williamson and colleagues studied 240 patients ages 16 and older whose
symptoms suggested that they had a sinus infection caused by bacteria. Viruses
also cause sinus infections, but antibiotics do not help viral infections.
Study patients received antibiotic treatment with amoxicillin, an antibiotic often used for
bacterial sinus infections, with or without nasal steroid sprays. A
fourth of the patients received no treatment at all, but just got inactive
placebo pills and placebo sprays.
Ten days later, patients who got no active treatment were just as likely to
be cured as those treated with antibiotics. Steroid nasal sprays made little
difference, although they seemed to help people with very mild nasal congestion
and seemed to make things a little worse for those with very intense nasal
congestion.
Williamson says the study does not definitively rule out some small effect
of antibiotics. But that effect would be very small.
"Over a three-week illness -- when your symptoms are not so bad -- would
the side effects from a long course of antibiotics be worth a day's less
illness? Overall we think antibiotics have a pretty small effect, if there is
one there at all," Williamson says.
A decade ago, a carefully controlled study by Norwegian sinusitis expert Morten Lindbaeck, MD, PhD, at the
University of Oslo showed that antibiotics had a detectable effect on bacterial
sinus infections -- but that the effect is quite modest.
"Even in these very strict cases with a large probability that patients
had really tough bacterial infections, more than half of patients were healthy
by 10 days," Lindbaeck tells WebMD. "Even if you have a real bacterial
infection, most of the time you get well without antibiotics."
What about people who don't get better? That remains a question.
"If they come to me and say, 'I have been sick for seven days and feel
very bad and have a fever,' I start antibiotics right away. But that is the
few," Lindbaek says. "The large majority of patients with sinus
infections are not very sick. They have pain, they are stuffy, they don't feel
well enough to go to work, but they are not very ill."
What's wrong with just giving patients antibiotics? Williamson and Lindbaek
both note that bacteria are becoming more and more resistant to antibiotic
drugs. And antibiotics that are not effective spur the growth of drug-resistant
bugs.
Lindbaek says that more cautious prescribing policies among Norwegian
doctors is one reason Norway has one-tenth as many important drug-resistant
bacteria as does the U.S.
And Williamson says patients and doctors should think about the future.
"It is a green issue," he suggests. "Maybe we will get away with
overusing antibiotics, but will our kids get away with it? We should use
antibiotics wisely. It is a resource we don't want to use up."
Williamson and colleagues report their findings in the Dec. 5 issue of
The Journal of the American Medical Association. An editorial by
Lindbaek appears in the same issue.
SOURCES: Williamson, I.G. Journal of the American Medical
Association, Dec. 5, 2007; vol 298: pp 2487-2496. Lindbaek, M. TheJournal of the American Medical Association, Dec. 5, 2007; vol 298: pp
2543-2544. Ian G. Williamson, MD, senior lecturer, University of Southampton,
England. Morten Lindbaek, MD, PhD, professor, University of Oslo, Norway.
© 2007 WebMD Inc. All rights reserved.
Cold and Flu RSS