Antibiotics No Help for Sinus Cold
Even After 10 Days of a Head Cold, Antibiotics Don't Help Sinus Infection
March 13, 2008 -- Even after suffering 10 days with a head cold, antibiotics
won't help your stuffy sinuses get better.
Antibiotics don't help virus infections, the cause of most head colds. But
after an adult patient has suffered stuffy sinuses for a week to 10 days, most
doctors offer antibiotic treatment in case a bacterial infection has set in.
Doctors may offer antibiotics even more promptly if the sinus infection is
dripping thick green phlegm into the throat.
But nasty snot or not, antibiotics aren't likely to help, find Jim Young,
PhD, of University Hospital, Basel, Switzerland, and colleagues.
Young's team painstakingly re-analyzed clinical data from each of 2,547
adults with mild-to-moderate sinus infections. The patients were participating
in one of nine different placebo-controlled clinical trials looking at whether
antibiotics speed recovery from acute sinus infections.
"We found that overall, you would need to treat 15 patients with
sinusitis-like symptoms for one patient to benefit," Young tells WebMD.
"If you are older, if you have more severe symptoms when you come to the
doctor's office, if you have symptoms longer, you will take longer to cure. But
antibiotics will be of no more benefit to you than to any other
Even people who really do have mild-to-moderate bacterial sinus infections
get better without antibiotic treatment, says sinusitis expert Morton Lindbaek,
MD, PhD, of the Antibiotic Center for Primary Care at the University of Oslo,
"It is even more safe than we had thought to wait and see if you get
better without antibiotics," Lindbaek tells WebMD. "But if you somehow
deteriorate or get worse, or take more than 10-14 days to get better, you must
see your doctor."
Ten days is a long time to suffer with a cold. But even those who have
suffered that long may take several more days to get better, Lindbaek and Young
The Young study looked at people who simply went to the doctor with symptoms
A recent clinical trial looked only at those patients most likely to have a
bacterial infection. Both studies came up with the same result: Antibiotics
aren't likely to help sinus infections.
Lindbaek warns that if you start feeling much worse, if you develop a high
fever, or if you have sharp sinus pain, all bets are off -- it's time to see a
doctor right away. And none of this applies to children, to people with immune
suppression, or to people who are seriously ill -- all of these patients should
see a doctor whenever they have sinusitis symptoms.
"Our findings are pretty sad, in a way, because we cannot distinguish
patients who really need antibiotics from those who do not," Young says.
"All we can say is most people won't need antibiotics for sinusitis. The
latest recommendation is for doctors to take a wait-and-see approach. They
should tell patients, 'If it gets worse, see me again.' For most patients, in a
week, things will have improved."
One thing that can help is to help the sinuses drain the mucus or pus that
clogs them, Lindbaek says. He suggests the use of intranasal steroids,
decongestants, or nasal lavage to improve drainage.
The Young study and an editorial by Lindbaek, appear in the March 15 issue
of The Lancet.