Sinusitis Treatments Found Ineffective

Sinusitis Treatments Found Ineffective
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasalsteroids work no better than a placebo in combating sinus infections, anew British study shows.
"Antibiotics are probably not as effective as have been previouslybelieved, particularly for the majority of cases of acute sinusitis," saidstudy author Dr. Ian Williamson, a senior lecturer in primary medical careat the University of Southampton. "Patients should turn more tosymptomatic remedies like analgesics while the body heals itself, usuallyover a period of three days to three weeks. Topical steroids have littleoverall effect, but may be beneficial, particularly in milder cases ofacute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-caresetting, many of these cases do not require treatment, and a more cautiousand conservative approach would seem to be warranted," added Dr. ReginaldF. Baugh, vice chairman of Texas A&M Health Science Center College ofMedicine and director of the division of otolaryngology at Scott &White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of theJournal of the American Medical Association, is no reason to scrapantibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemnantibiotics in those people who need them," said Dr. Michael Stewart,chairman of the department of otolaryngology at New YorkPresbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial andwill respond to antibiotics. The majority are viral infections, whichwon't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25million doctor's office visits in the United States each year. Antibioticsare used to treat sinus infections 85 percent to 98 percent of the time inthe United States.
Overuse of antibiotics not only won't help a patient with a viralinfection get better, it will contribute to the growing problem ofantibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no questionabout that," Baugh said.
For this study, 240 adults with sinus infections were randomized to oneof four treatment groups: 500 milligrams of the antibiotic amoxicillinthree times a day for seven days plus 200 micrograms of the nasal steroidbudesonide once a day for 10 days; a placebo in place of the antibioticplus budesonide; amoxicillin plus a placebo in place of budesonide; or twoplacebos.
In the amoxicillin group, 29 percent of patients had symptoms lastingat least 10 days, and 33.6 percent of those not receiving amoxicillin hadthe same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percentof patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who hadless severe symptoms.
As the editorial pointed out, most patients with acute sinusitis willget better on their own. Unfortunately, there's no good way to determinewho has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baughsaid.
If the symptoms are worse, treatment might be warranted, he added."But for the bulk, I would assume it would be more of a wait-and-seeapproach. The bugs are winning," he said.
While researchers investigate possible new treatments, sinus infectionssufferers might look to analgesics or brief use of steam inhalations,Williamson said.
Dr. William Morris, chairman and director of the department ofosteopathic manipulative medicine at Touro College of Osteopathic Medicinein New York City, recommends an alternative approach: manual pressure tothe bottom of the head and beginning of the neck, to allow better drainagefrom the head.
"One of the problems with sinusitis is that the sinuses tend to getclosed up," he said. "If you don't drain properly, bacteria is just happyas a clam. If you can increase drainage and improve flow through thesinuses, you're going to be facilitating the process."
More information
For more on sinus infections, head to the U.S. Centers for Disease Control andPrevention.