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Some Common Sinus Treatments May Not Be Effective

Antibiotics, steroids no better than placebo, study finds

December 4, 2007

• Chronic Sinus Problems Require Treatment • Some Common Sinus Treatments May Not Be Effective • Study: Antibiotics Overprescribed for Sinus Infections --- • More Health News ...

A comparison of common treatments for acute sinus infection that included an antibiotic and a topical steroid found neither more effective than a placebo, according to a study in the December 5 issue of JAMA.

Acute sinus infection (sinusitis) is a common clinical problem with symptoms similar to other illnesses, and is often diagnosed and treated without clinical confirmation.

Despite the clinical uncertainty as to a bacterial cause, antibiotic prescribing rates remain as high as 92 percent in the United Kingdom and 85 percent to 98 percent in the United States.

“Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring,” the authors write. Concerns about widespread antibacterial use include increasing antibiotic resistance in the community.

Anti-inflammatory drugs such as topical steroids are also used as a treatment and may be beneficial, but there has been limited research.

University of Southampton, England, researchers led by Ian G. Williamson, M.D., conducted a double-blind randomized placebo-controlled trial to determine the effectiveness of the antibiotic amoxicillin and topical steroid budesonide in acute maxillary sinusitis (rhinosinusitis; inflammation of the nasal cavity and sinuses).

The study included 240 adults with acute nonrecurrent sinusitis treated at 58 family practice.

Patients were randomized to 1 of 4 treatment groups: antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 μg of budesonide in each nostril once per day for 10 days); placebo antibiotic and nasal steroid; antibiotic and placebo nasal steroid; placebo antibiotic and placebo nasal steroid.

The researchers found that the proportions of patients with symptoms lasting 10 or more days were 29 percent for amoxicillin vs. 33.6 percent for no amoxicillin; and 31.4 percent for topical budesonide vs. 31.4 percent for no budesonide. Secondary analysis suggested that nasal steroids were significantly more effective in patients with less severe symptoms at baseline.

Neither is effective

“Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with such features but who have less severe symptoms at presentation to the physician,” the authors write.

In an accompanying editorial, Morten Lindbaek, M.D., of the University of Oslo, Norway, writes that, “The study by Williamson et al…reinforces the lack of benefit from antibiotics shown in a number of other studies that recruited patients based on clinical symptoms and findings..”

At the same time, Lindbaek points out that, “some patients with sinusitis are more ill than others with fever, malaise, and deteriorated general condition. These patients still are in need of antibiotics, although they are relatively uncommon in general practice.”

Lindbaek writes that at this point, “there is no reliable way to distinguish viral sinusitis from bacterial sinusitis in the general practice setting, and a point of care test that could single out patients who could benefit from antibiotic treatment is not available.”

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