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WITH ACUTE SINUSITIS, ANTIBIOTICS SCORE WORSE THAN THE PLACEBO

Doctors often prescribe antibiotics for children who have acute sinusitis, but a new study suggests that the drugs do not help most of them. Writing in the current issue of Pediatrics, the researchers said that in most cases, the children got better on their own within three weeks. So doctors should hold off giving antibiotics, […]

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Originally Published: April 22, 2001 at 1:00 AM CDT

Antibiotics Overprescribed For Sinusitis? - CBS News

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 percent to 5 percent 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 bedue 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 andchronic when they persist for three months or longer.

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

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

In the newly published study, Leopold, Hadley J. Sharp, and colleagues fromthe University of Nebraska Medical Center examined data from two NationalCenter 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 roughly14.2 million health care visits for chronic sinus infections and 3.1 millionvisits for acute sinus issues during the time period.

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

Penicillins were the most commonly prescribed antibiotics, followed bycephalosporins — another class of antibiotics. Antibiotics were prescribed 70 precent of the time during health care visits for chronic sinus infections and 83 percent of the time for acute sinus infections.

"The vast use of [antibiotics] makes the statement that they seem to beeffective 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 theoverprescribing of antibiotics is largely driven by patient expectations.

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

"In this country, I really don't think we have gotten to the point where wetell patients they don't need antibiotics."

Benninger adds that he is somewhat surprised by the latest findings, giventhe 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 betterapproach for many patients with chronic sinus problems, he adds.

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

Leopold and Benninger agree that one of te best treatments for nonbacterialacute 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.

Reviewed by Louise Chang©2007 WebMD, Inc. All rights reserved

Outpatient Acute Sinusitis: Antibiotic Prescribing Patterns Vary By ...

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