Antibiotics Do Not Reduce Symptoms of Sinus Infection
Medications Don't Speed Recovery, but May Increase Antibiotic Resistance
The authors recruited adults with sinusitis from 10 offices of primary care physicians in St. Louis, Mo.
Participants were 166 adults ages 18 to 70 who met specific national diagnostic criteria for sinusitis. Per the recommendations of the CDC expert panel guidelines on sinusitis, only patients with moderate, severe, or very severe symptoms were included.
Of the 166 patients, 85 were randomly assigned to receive a 10-day course of amoxicillin and 81 received a placebo. Both groups were also given a five- to-seven day supply of medications to provide symptom relief, such as acetaminophen for pain or fever and pseudoephedrine for nasal congestion.
Researchers assessed patients with a standardized measure of sinus-related symptoms called the Sinonasal Outcome Test-16, or SNOT-16. With the SNOT-16, patients rated how much each of 16 sinus-related symptoms bothered them within the past few days. To track their symptoms, patients also used a six-point scale to assess symptom change.
Watch and Wait
Garbutt and her colleagues point to guidelines in the U.K. and some more recent guidelines in the U.S. that suggest “watchful waiting” instead of treatment with antibiotics when possible in patients with less severe sinusitis.
“If it’s just usual, uncomplicated [sudden-onset] sinusitis that forms the majority of the patients, we would suggest that the doctor have a conversation with the patient, explain that they think it’s more likely to be viral than bacterial and that they’re going to be well within 10 days, and that they should use a painkiller, and that they really don’t think there’s any clinical benefit to them of taking the antibiotic,” Garbutt says.