Antibiotics Overused for Sinusitis

Most Sinus Problems Caused by Viruses, Inflammation

Medically Reviewed by Louise Chang, MD on March 19, 2007
From the WebMD Archives

March 19, 2007 -- Antibiotics are still being widely overprescribed for sinusitis, though the majority of these illnesses are caused by viruses, new research shows.

Studies suggest that only about 3% to 5% of acute sinus infections are bacterial in nature, meaning that they respond to antibiotic treatment.

Using data derived from two national studies of prescription practices, researchers concluded that antibiotics were prescribed for slightly more than four out of five patients with acute sinusitis and two-thirds of patients with chronic sinusitis.

“By the current guidelines it does appear that antibiotics are being overused,” study researcher Donald A. Leopold, MD, tells WebMD. “This may be due to the fact that we feel the need to give patients something and there are not a lot of effective treatments. And it could be that antibiotics really do help patients feel better.”

Antibiotics Prescribed Most Often

Rhinosinusitis is an inflammation of the nasal passageway and sinus cavities. Symptoms are considered acute when they last up to four weeks and chronic when they persist for three months or longer.

Acute sinusitis is usually caused by viral infections. The causes of chronic sinusitis are not as well understood, but they are thought to be driven by inflammation.

Though there has been a general feeling that antibiotics are overprescribed in the treatment of sinus infections and other sinus-related illness, little research has been done to confirm this.

In the newly published study, Leopold, Hadley J. Sharp, and colleagues from the University of Nebraska Medical Center examined data from two National Center for Health Statistics surveys assessing prescribing practices for sinus infections in physicians’ offices and hospital ERs.

The surveys were conducted between 1999 and 2002, and they included roughly 14.2 million health care visits for chronic sinus infections and 3.1 million visits for acute sinus issues during the time period.

The most widely prescribed treatments for both acute and chronic sinus infections were antibiotics, followed by antihistamines, nasal decongestants, inhaled corticosteroids, and expectorants and other antimucus agents.

Penicillins were the most commonly prescribed antibiotics, followed by cephalosporins -- another class of antibiotics. Antibiotics were prescribed 70% of the time during health care visits for chronic sinus infections and 83% of the time for acute sinus infections.

“The vast use of [antibiotics] makes the statement that they seem to be effective in reducing symptoms or preventing relapse, or they would have been abandoned,” Leopold and colleagues write. “Another important possibility is that many patients have self-limited disease that will resolve regardless of treatment, and their physicians could be prescribing what they think will work.”

Inhaled Steroids and Saline Sprays

Ear, nose, and throat specialist Michael Benninger, MD, tells WebMD that the overprescribing of antibiotics is largely driven by patient expectations.

He points out that in Europe, antibiotics are rarely prescribed for sinus infections.

“In this country, I really don’t think we have gotten to the point where we tell patients they don’t need antibiotics.”

Benninger adds that he is somewhat surprised by the latest findings, given the concerns about antibiotic overuse spurring resistance to the drugs.

“The bottom line is we should not be treating a virus with an antibiotic, and we should not assume that antibiotics are the best treatment for acute or chronic rhinosinusitis,” he says.

Inhaled steroids, used to reduce inflammation, appear to be a better approach for many patients with chronic sinus problems, he adds.

But this treatment was prescribed only 16.4% of the time to patients in the study with chronic symptoms.

Leopold and Benninger agree that one of the best treatments for nonbacterial acute sinus infections is also one of the simplest.

Flushing the nose frequently with a saline nasal spray is a highly effective, over-the-counter therapeutic approach, Leopold says. He recommends that patients start using saline sprays when they feel upper respiratory symptoms coming on.

“My patients are sick of hearing about this, but saline therapy is cheap, effective, and underutilized,” he says.

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SOURCES: Sharp, H.J. Archives of Otolaryngology and Head and Neck Surgery, March 2007; vol 133: pp 260-265. Donald A. Leopold, MD, professor and chairman, department of otolaryngology, head and neck surgery, University of Nebraska Medical Center, Omaha, Neb. Michael Benninger, MD, chairman, department of otolaryngology, head and neck surgery, Henry Ford Medical Group and Hospital, Detroit.

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