Antibiotics No Help for Sinusitis

Antibiotics won't chase away patients' sniffles any faster than watchful waiting, researchers found.

In a randomized trial, patients with acute rhinosinusitis had no differences in symptoms or quality of life three days after starting on amoxicillin compared with patients who received a placebo instead, Jay Piccirillo, MD, of Washington University in St. Louis, and colleagues reported in the Journal of the American Medical Association.

"It provides further evidence for what we've really suspected for a long time -- that in the management of patients with acute sinusitis, antibiotics do not convey any additional benefit," Piccirillo said in The JAMA Report.

Lee Green, MD, MPH, of the University of Michigan in Ann Arbor, who wasn't involved in the study, said it's "no surprise that [amoxicillin] doesn't help. Sinusitis is almost always viral anyway."

In an email to MedPage Today, he also criticized physicians who prescribe azithromycin (Zithromax Z-Pak) for sinus infections.

"If anything, it's less effective," he said. "The prevalence of its prescribing represents sloppy practice. It's a fad."

Antibiotics are commonly used to treat sinusitis, even though there's limited evidence to support their use in the disease, as well as serious concern about the wider problem of antibiotic resistance.

The most current CDC guidelines recommend treating only severe rhinosinusitis cases with antibiotics, the researchers said.

They conducted a randomized, controlled trial of 166 adults with acute rhinosinusitis who were treated at 10 community practices in Missouri.

Patients were given either a 10-day course of amoxicillin (1,500 mg/day) or placebo at three doses per day. Their symptoms and disease-specific quality of life -- as measured by the Sinonasal Outcome Test (SNOT-16) -- were assessed during their 10 days of treatment.

All patients also had the option of taking other medications to relieve symptoms including pain, fever, cough, and nasal congestion on an as-needed basis.

The primary outcome was improvement in disease-related quality of life three days after starting treatment.

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