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Antibiotics may not help sinus infections

Published: 10 December 2007

The widespread use of standard antibiotics to treat sinus infections does not help cure patients and may harm them by increasing their resistance to the drugs, according to a study from the University of Southampton.

The researchers found that the percentage of patients who recovered in 10 days was about the same whether they took an antibiotic or a placebo.

"With a little bit of patience, the body will usually heal itself," said Dr Ian Williamson, a family medicine researcher at the University of Southampton and lead author of the paper published in the 5 December issue of the Journal of the American Medical Association.

The results showed that patients should be more willing to forgo antibiotics, although they should still check with their doctors when a cold worsens into a sinus infection.

Acute sinusitis (sinus infection) is an inflammation of the sinuses that commonly develops as a complication from a cold and is often diagnosed and treated without clinical confirmation. Allergies can also cause sinusitis, but researchers in this study focused on cases likely to be caused by bacteria.

Despite the clinical uncertainty as to a bacterial cause, antibiotic prescribing rates remain as high as 92 per cent in the United Kingdom and 85 to 98 per cent in the United States, according to background information in the article. Concerns about widespread antibacterial use include increasing antibiotic resistance in the community.

In the latest study, which was funded by the Department of Health, Dr Williamson and his colleagues looked at the cases of around 200 sick adults from GP surgeries in South West England.

Of the 100 patients who took the antibiotic amoxicillin, 29 per cent had symptoms lasting 10 or more days. Of the 107 patients taking a placebo, about 34 per cent of patients had symptoms of a similar length. Researchers deemed the difference statistically insignificant.

Dr Williamson comments: "We surmised that the antibiotic was ineffective because it had trouble penetrating mucus-filled sinus cavities. Though we did not test other antibiotics, they probably would fare no better because amoxicillin is considered the most appropriate drug for sinusitis."

The researchers also tested the efficacy of a nasal steroid spray called budesonide because it was thought to reduce inflammation.

The proportion of patients in the steroid group and the placebo group who had symptoms lasting 10 or more days was the same at 31 per cent. The researchers found that the nasal spray helped a subset of patients with milder symptoms who reported feeling less ill by day 10.

Dr Williamson adds: "Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with less severe symptoms."

 

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