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Antibiotics no better than placebo for treating sinus infections, study finds

Pink and brown antibiotic pills
CC/Flickr/AJC1
Antibiotics are not effective in treating sinus infections.

Some 20 percent of antibiotic prescriptions in the United States are written for sinus infections, despite scant scientific evidence that such treatments actually work — and despite deep concerns that the unnecessary use of antibiotics is leading to the very serious worldwide problem of antibiotic resistance.

But the routine prescribing of antibiotics for common sinus infections (sinusitis) may soon be a thing of the past, thanks to the results of a randomized trial (the gold standard of research studies) published Tuesday in the Journal of the American Medical Association (JAMA).

The new study found that antibiotics do not ease the symptoms of a sinus infection any faster than a placebo pill. Nor do they help sinus-infection sufferers return to their normal daily activities any more quickly.

The study instead confirmed what many health professionals already suspected: Most uncomplicated cases of sinus infection clear up on their own within 10 to 14 days, with or without antibiotics.

Study details

For the study, researchers at Washington University in St. Louis randomly assigned 166 patients, ages 18 to 70, to either a placebo or a 10-day treatment with the antibiotic amoxicillin (500 milligrams three times a day). All the patients had been diagnosed with moderate, severe or very severe symptoms of a sinus infection — such things as congestion, cough, headaches, running nose, sore throat and fever.

All participants were also told they could take over-the-counter pain relievers, nasal decongestants and other medications to relieve their symptoms, if they wished.

Three days after starting treatment, the people in the placebo and amoxicillin groups showed little difference in symptom relief. At day seven, more people in the amoxicillin group reported symptom improvement, but that difference disappeared by day 10. At that point, similar numbers of people in both groups reported that their symptoms were either much improved or gone altogether.

The study also found no difference between the groups in satisfaction with the treatment, missed days from work, and likelihood of a relapse of symptoms.

The study’s authors concluded that watchful waiting is a better approach to the management of sinus infections than antibiotics.

Why antibiotics seldom work

A major reason for antibiotics’ ineffectiveness against sinus infections is because viruses are almost always the source of such infections. Antibiotics are worthless against viral infections.

Currently, most doctors have no way of determining whether a bacterium or a virus is the source of a sinus infection. But, as the Centers for Disease Control and Prevention point out, bacterial sinus infections are very rare. The authors of the JAMA study suggest following a treatment strategy they say is more commonly used in Europe: Give patients with sinus infections a prescription for antibiotics, but tell them not to use them unless their symptoms worsen or persist.

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Comments (5)

Already Practiced

It's incorrect to say that, "routine prescribing of antibiotics for common sinus infections (sinusitis) may soon be a thing of the past." My wife is a provider and this has been known for some time in the medical community. Current treatment recommendations for sinus infections is to wait 10-14 days and if it doesn't clear up, then prescribe antibiotics.

We need lots of patient education. We've got so used to popping a pill to clear up everything that patients can get downright angry when they are told the pill won't work and won't be prescribed.

Antibiotic Overuse

It is more likely that the infection was caused by a virus and cleared up after 10-14 days, coincidental with the use of a second antibiotic.

Antibiotics use is not without risks, the primary of which is resistance buildup. But even for the patient, antibiotics kill beneficial gut bacteria and can lead to intestinal infections when the missing bacteria are not there to keep harmful bacteria in check.

My spouse has had sinus

My spouse has had sinus surgery twice for reoccurring sinus infections. Sinus infections so bad that the MRI's showed completely filled up sinus cavities.

Amoxicillin never worked for him. It always took at least Levaquin and he just finished a three work course of Cleocin to treat his current sinus infection. I get very, very tired of the constant antibiotic resistance cry mostly because it is only applied to people and not to the over-use of antibiotics in farm animals. When I read articles like this, I become extremely frustrated because that cause of antibiotic resistance is never mentioned.

What Does Work

Until about a year ago, I had a chronic problem with sinus infections. I'd get them 4 times a year or so. Sometimes if I toughed it out long enough they'd go away, but other times I'd get a prescription for amoxicillin. Amoxicillin would only knock it back for a couple of months or so, and then it would be back. I think it was really just one long chronic infection that never really went away. I've also had ear infections that were only suppressed, but not cured, by amoxicillin, so I tend to think that amoxicillin has been so overused that the germs are resistant and amoxicillin is largely useless.

Last year I had a sinus infection most of the winter, and in particular a 10 week stretch from February into April. I didn't go in for antibiotics because another round of amoxicillin seemed pointless. However, sinus infections result in some serious fatigue for me, and that was becoming a real problem. Casting about for other solutions, I finally tried colloidal silver nasal spray. I'd read about colloidal silver before, but always shied away from it because of the stories about argyria. I decided to try it out of desperation, because the sinus infection problem needed a permanent fix, and the M.D.'s had been unable to provide one. Wonder of wonders, it worked! The infection was gone within a week, and hasn't returned. I spray a little bit up there once or twice a month for a day or two as a preventative, and I no longer have sinus infections.

I'm not worried about argyria for several reasons. First, all the cases I've read about involve people who make their own colloidal silver home brew, and ingest way too much of it. I buy from a reputable company that has their solution tested by outside labs every year, to verify that the silver content is as advertised, and consistent from batch to batch. Second, I only use nasal spray, not the drinkable kind, so I doubt that I'm getting enough silver to turn my skin blue. And third, I'm doubly sure of that because I happen to be allergic to silver (skin irritation if I wear a silver ring), so I can only use a little bit without provoking some tissue inflammation.

There is no doubt that silver kills bacteria (it suffocates them by binding silver ions to an enzyme the bacteria need to process oxygen), and it appears that only a little is necessary to kill the surface bacteria responsible for sinus infections, so my problem is fixed permanently. I can't tell you what a relief that is. Anyone with a chronic infection ought to try it - it's cheap and fixes the problem once and for all - something the doctors seem unable to do.

This was a good piece, Susan.

This was a good piece, Susan. Thanks.

Dr. Rano’s approach strikes me as time-and-cost-prohibitive, but it’s hard not to agree with David Green. Most patients, including this one on occasion, are remarkably lacking in knowledge about how various common ailments work, and what the most effective treatments for them usually are.