Review: Doctors Should Consider Alternatives to Antibiotics for Sinusitis

[Guest guest]

Review: Doctors Should Consider Alternatives to Antibiotics for

Sinusitis

Newswise*

http://www.newswise.com/articles/view/540098/

Newswise — When suffering through a sinus infection, many people ask

for an antibiotic to speed their recovery. However, a recent review

of clinical trials found that while antibiotics can provide minor

improvements in uncomplicated sinusitis cases, most patients recover

without the drugs within two weeks.

The health risks for the individual and society might override the

benefits of antibiotics for people suffering with a simple sinus

infection, according to authors led by Anneli Ahovuo-Saloranta of

the Finnish Office for Health Technology.

The systematic review examined the results of 57 studies, six of

which compared antibiotics to a placebo and 51 of which compared

different kinds of antibiotics. More than 18,000 people took part in

the studies.

This review focused on studies with patients treated for simple,

uncomplicated sinusitis in a primary care setting. Four of five

patients without complications improved within two weeks even

without a prescription for antibiotics.

At 10 to 14 days after diagnosis, 52 percent of patients had

recovered completely in the antibiotic group compared with 38

percent in placebo group. However, when researchers waited longer to

check back with the patients, there was no significant difference in

recovery rates whether people took antibiotics or a placebo.

The evaluation of different antibiotics showed them to be similarly

effective.

The review appears in the latest issue of The Cochrane Library, a

publication of The Cochrane Collaboration, an international

organization that evaluates medical research. Systematic reviews

draw evidence-based conclusions about medical practice after

considering both the content and quality of existing medical trials

on a topic.

Sinusitis is a common disease that, in many cases, resolves

spontaneously, the review authors said. However, in patients with

severe symptoms, like high fever, severe pain in cheeks and swelling

of face, antibiotic treatment is justified, the reviewers conclude.

Every year, 20 million people in the United States have sinusitis.

When the membrane-lined air spaces near the nose become infected,

sinusitis can cause nasal discharge, pain, obstruction, poor

response to decongestants, facial pain and even toothache.

Viral upper respiratory tract infections often precede sinus

infections and antibiotics have no effect on viral diseases.

Antibiotics kill bacteria, not viruses. Some cases of sinusitis are

bacterial, which would mean that antibiotics might help, but

distinguishing patients with a bacterial infection remains a

challenge.

" Without a positive bacterial culture by sinus puncture, it is hard

to separate viral from bacterial sinusitis, " said Ed Septimus, M.D.,

a board member of the Infectious Diseases Society of America and a

member of the society's Antimicrobial Resistance Work Group.

Acute bacterial sinusitis is more likely if symptoms have lasted

more than a week. Even so, patients with bacterial sinusitis do not

always benefit from antibiotics.

Even bacterial sinusitis can resolve spontaneously. According to the

review authors, some patients with simple sinusitis would benefit

from antibiotics, but it is still unclear who those patients are.

Current criteria for sinusitis cannot reliably identify those

patients who would most benefit from antibiotics.

On the other hand, antibiotics have well-documented negative

effects. Potential adverse effects include gastrointestinal problems

such as diarrhea, abdominal pain and vomiting, allergic symptoms and

antibiotic-related fungal infections.

The unnecessary prescribing of antibiotics might also prove

problematic for the general population. " Overuse of antibiotics

leads to antimicrobial resistance, " Septimus said.

The bacteria that antibiotics are designed to kill can change and

become resistant to available medicines, and the same class of drugs

might no longer be useful in the future.

Current treatment recommendations span from only using narrow-

spectrum antibiotics to treat patients with severe or persistent,

moderate symptoms and specific bacterial sinusitis findings to using

broad-spectrum antibiotics to treat all patients with acute

bacterial infections.

Treatment should always occur on a case-by-case basis considering

the benefits and harms on individual patient level, but in light of

the results of this study, doctors might want to consider other

treatment options, the study authors said.

Patients can use symptom-relieving drugs like nasal decongestants

and the anti-inflammatory analgesics as well as nasal irrigation.

Also in those patients who have asthma or allergic rhinitis, nasal

corticosteroids and antihistamines can be helpful.

Ahovuo-Saloranta A, et al. Antibiotics for acute maxillary sinusitis

(Review). Cochrane Database of Systematic Reviews 2008, Issue 2.

The Cochrane Collaboration is an international non-profit,

independent organization that produces and disseminates systematic

reviews of health care interventions and promotes the search for

evidence in the form of clinical trials and other studies of

interventions. Visit http://www.cochrane.org for more information.