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 patient."
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, Norway.
"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 say.
The Young study looked at people who simply went to the doctor with symptoms of sinusitis. 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.