Antibiotics don’t work for most sinus infections, study suggests

By Deborah Kotz, Globe Staff

Doctors routinely treat painful sinus infections with antibiotics, but a new study questions the wisdom of that practice because the drugs worked no better than placebos at clearing up symptoms. The finding suggests that doctors may want to switch to monitoring many patients with sinus infections to see whether symptoms worsen instead of immediately handing them a prescription.

In the research published today in the Journal of the American Medical Association, 166 adults who were recently diagnosed with sinus infections -- because of symptoms such as a stuffed and runny nose, sinus pressure, and facial pain that often stem from a lingering cold -- were randomly assigned to take the antibiotic amoxicillin or a placebo for 10 days while their symptoms were regularly monitored. On day three, 37 percent of the amoxicillin group reported feeling significantly better, compared with 34 percent of the control group. By day 10, about 80 percent of those in both groups said their symptoms had improved.

“We did see a difference on day seven, with more of those in the amoxicillin group experiencing relief, but the difference was so small -- 0.19 on a scale of 0 to 3 -- that it was barely detectable,” said study author Dr. Jane M. Garbutt, a research associate at Washington University School of Medicine in St Louis.

How to explain the results?

“I think more often than not, these infections are viral,” said Garbutt, “so antibiotics aren’t going to help.” While some people with sinus infections actually do have a bacterial infection, she added, they can’t be distinguished from those who have viruses since there’s no simple way to draw a sample from the sinus cavity, short of surgery.

“Our findings suggest it might be more appropriate to just follow patients,” said Garbutt, and if their symptoms persist or get worse, doctors can then prescribe antibiotics because bacterial infections often linger.

Under current practice guidelines endorsed by the federal Centers for Disease Control and Prevention and many medical societies, doctors should prescribe antibiotics only to those with severe symptoms or to those who symptoms have persisted for more than seven days. The study, however, included those who fell into the category and found that antibiotics still didn’t help -- indicating that perhaps doctors should wait even longer before prescribing the drugs.

The CDC points out on its website that viral sinusitis typically lasts for less than four weeks and usually occurs after a cold, whereas bacterial sinusitis can produce symptoms for four to 12 weeks.

“I think it will change my practice,” said Dr. Jeffery Linder, an internist at Brigham and Women’s Hospital. “I normally follow the guidelines but given the finding I might wait a bit longer before prescribing antibiotics to patients whose symptoms last longer than a week.”

While antibiotics carry a low risk of serious side effects such as life-threatening allergic reactions, they can cause an upset stomach and diarrhea and can interfere with common medications including birth control pills and the blood thinner warfarin. Overuse of antibiotics has also become a public health concern with the rise of drug-resistant infections such as methicillin-resistant staphylococcus aureus (MRSA).

Whether doctors decide to take a watchful-waiting approach to sinus infections remains to be seen. Many still prescribe antibiotics for bronchitis and minor pediatric ear infections despite evidence showing that these infections are usually caused by viruses, not bacteria.

That, though, doesn’t mean that those suffering from sinus infections should be left without any treatments to relieve their symptoms. Over-the-counter pain relievers such as ibuprofen can help ease facial discomfort and reduce inflammation, but Linder said it’s also important to try to unclog nasal passages -- both to ease symptoms and help clear the infection. He recommends decongestant nasal sprays like Afrin, though they shouldn’t be used for more than a few days to avoid becoming dependent on them.

Some people also feel less congested from sipping hot fluids, applying a warm, wet compress to their face, or using a warm vaporizer. Sinus sufferers can also try using a saline nasal spray, Linder added, or neti pot -- which has a spout through which saline solution is poured gently into the nostrils -- to help flush mucus out of sinuses.

Related: 7 Mistakes we make when treating colds