herald

Saturday 16 December 2017

Experts get sniffy about use of sinus antibiotics

STUDY: Drugs are useless against virus

ANTIBIOTICS don't help fight most sinus infections, although doctors routinely prescribe them for that purpose, according to a US study.

Researchers found that antibiotics didn't ease patients' symptoms or get them back to work any sooner than an inactive placebo pill.

Antibiotics are known to fuel the evolution of drug-resistant bacteria and experts have grown increasingly worried about overuse.

This is a particular concern with sinus infections, because doctors can't tell if the disease is caused by bacteria or by a virus, in which case antibiotics are useless.

"There is not much to be gained from antibiotics," said Jane Garbutt of Washington University School of Medicine in St Louis, who led the study.

"Rather than give everybody an antibiotic hoping to find the (patients) with bacteria, our findings would suggest refraining from antibiotics and doing what we call watchful waiting," she said.

That involves keeping an eye on patients to see if they get better, but not using drugs other than over-the-counter painkillers.

People with sinus infections, also called acute sinusitis, have lasting and severe cold-like symptoms such as a runny nose and pain around the eyes, nose or forehead.

"It's the fifth most common reason antibiotics are prescribed for adults. It's hard for doctors not to give an antibiotic because patients are so miserable, and we don't have anything else to give them," said Garbutt.

Garbutt and her colleagues randomly assigned 166 adults to either placebo pills or a 10-day treatment with the antibiotic amoxicillin.

Based on patient ratings on a symptom scale known as the modified Sinonasal Outcome Test-16, or SNOT-16, the researchers found little difference between the two groups.



Vanished

Using the scale, where 0 equals "no problem" and 3 a "severe problem," the antibiotic group rated their symptoms at 1.12 after three days, while the placebo group averaged 1.14.

After seven days, there were signs of benefit from the antibiotic, but the effect was small and had vanished another three days later.

After 10 days, 78pc of the people on antibiotics and 80pc of the placebo-treated people said they felt a lot better.

Fewer than 2pc of sinus infections are bacterial, said Anthony Chow, an expert in infectious diseases at the University of British Columbia in Vancouver.

"Most cases are viral, and the vast majority don't require antibiotics," he said.

"Antibiotics have been abused, so there is a need to be more cautious in prescribing them and to hold back."

hnews@herald.ie

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