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Antibiotics may not help sinus infections

A study comparing the use of a placebo with the drug finds little difference. Patience and over-the-counter remedies are preferred.

December 05, 2007|Jia-Rui Chong | Times Staff Writer

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 released Tuesday.

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 in England and lead author of the paper published today in the Journal of the American Medical Assn.

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, he said.

Dr. Daniel Merenstein, a family physician at Georgetown University in Washington, who was not involved in the study, said the report was more evidence of the overuse of antibiotics, which has caused enormous problems with drug resistance.

More than 80% of American physicians prescribe antibiotics for sinus infections, he said. Recent studies also have shown that antibiotics are unnecessary for treating ear infections and bronchitis.

"Doctors and patients get into habits and use antibiotics," Merenstein said. "Now people know . . . we should just give supportive care," such as pain relievers and saline nasal mists.

Sinusitis is an inflammation of the sinuses that commonly develops as a complication from a cold.

Allergies can also cause sinusitis, but researchers in this study focused on cases likely to be caused by bacteria.

Bacterial cases often lead to localized pain in the face and to thick discharges from the nose, with more coming from one nostril.

In the latest study, which was funded by the British government, Williamson and his group looked at about 200 sick adults from family practice offices around southwestern England.

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

Williamson surmised that the antibiotic was ineffective because it had trouble penetrating pus-filled sinus cavities. Though the researchers did not test other antibiotics, he said, 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%.

The researchers found that the nasal spray helped a subset of patients with milder symptoms who reported feeling less ill by day 10. Williamson said the spray probably helped in milder cases because it wasn't washed away as quickly as it was in sicker patients with more nasal discharges.

jia-rui.chong@latimes.com

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