October 2008

Antibiotics questioned for sinus infections

When suffering through a sinus infection, many people ask for an antibiotic to speed their recovery, and their medical doctors gladly write out prescriptions.

However, the health risks for the individual and society might override the benefits of antibiotics for people suffering with a simple sinus infection, according to researchers led by Anneli Ahovuo-Saloranta of the Finnish Office for Health Technology.

The researchers reviewed the results of 57 studies, six of which compared antibiotics to a placebo and 51 of which compared different kinds of antibiotics. More than 18,000 people took part in the studies.

This review focused on studies with patients treated for simple, uncomplicated sinusitis in a primary care setting. Four of five patients without complications improved within two weeks even without a prescription for antibiotics.

At 10 to 14 days after diagnosis, 52% of patients had recovered completely in the antibiotic group compared with 38% in placebo group. Yet, when researchers waited longer to check back with the patients, there was no significant difference in recovery rates whether people took antibiotics or a placebo.

The review appears in The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research.

According to the review authors, some patients with simple sinusitis might benefit from antibiotics, but it is still unclear who those patients are. Current criteria for sinusitis cannot reliably identify those patients who would most benefit from antibiotics.

On the other hand, antibiotics have well-documented negative effects. Potential adverse effects include gastrointestinal problems such as diarrhea, abdominal pain and vomiting, allergic symptoms and antibiotic-related fungal infections.

The unnecessary prescribing of antibiotics might also prove problematic for the general population.

"Overuse of antibiotics leads to antimicrobial resistance," stated Ed Septimus, MD, a board member of the Infectious Diseases Society of America and a member of the society's Antimicrobial Resistance Work Group. The bacteria that antibiotics are designed to kill can change and become resistant to available medicines, and the same class of drugs might no longer be useful in the future.

SOURCE: "Antibiotics for acute maxillary sinusitis (Review)" Ahovuo-Saloranta A, et al. Cochrane Database of Systematic Reviews 2008, Issue 2.