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.
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.