Antibiotics for sinus problems 'don't work'
Publication Date:04/12/2007
Doctors prescribe antibiotics to as many as 9 in 10 patients with inflamed sinuses (sinusitis). But for most of these patients, antibiotics do no good at all, according to a new study.
What do we know already?
Sinus problems are common, with most doctors seeing about one case a week. There are lots of possible causes, including allergies, bacteria or a virus.
Blocked sinuses can be painful, and many doctors prescribe antibiotics to try to shorten the illness. However, most of the time, doctors won't know what's caused your sinus trouble. Although antibiotics kill bacteria, they won't help anyone whose illness is caused by a virus or an allergy. Even for people who have a bacterial infection, doctors aren't sure that medicine from antibiotic tablets gets to the sinuses where it's needed.
Steroid nasal sprays are another treatment for sinus problems. You can buy some of these without a prescription from a pharmacy. They work by reducing inflammation, so they might help with several different causes of sinus problems.
More and more, doctors are trying not to prescribe antibiotics unless people really need them. Using antibiotics too much can mean bacteria develop a resistance to them, and become harder to kill in future. Also, people with inflamed sinuses usually get better on their own after a week or so. Researchers have done a study looking at whether antibiotics really make a difference. They also looked at whether steroid sprays work, either on their own or together with antibiotics.
What does the new study say?
For most people in the study, there was no benefit to taking either antibiotic tablets or steroid nasal sprays. About 7 in 10 people were completely better after 10 days. It didn't matter whether they'd taken antibiotics, steroids or a dummy treatment (placebo). Even taking antibiotics and a steroid spray together didn't seem to help.
A few people in the study, who had a milder illness to start with, did benefit from steroid sprays. But there was no benefit for people who had more severe symptoms.
Where does the study come from?
Most of the researchers were based at the University of Southampton. The study appeared in the Journal of the American Medical Association, published by the American Medical Association.
How reliable are the findings?
The study was well-designed, so the results should be reliable. However, it only looked at 240 people, so it's possible that antibiotics had a small benefit that the study missed.
What does this mean for me?
Doctors often prescribe antibiotics for sinus problems, even though the research doesn't show a clear benefit for many people. As an alternative, some doctors have tried writing a prescription and suggesting you only use it if you're not feeling better after a few days. That way, if you recover, you don't need to bother with treatment. If you're still feeling ill, you can pick up your antibiotics and see if they help.
The research looked at people who visited their GP with sinus problems. These people are likely to be fairly healthy most of the time. People who become very ill with sinus problems, and also have a high temperature, are still likely to be given antibiotics.
What should I do now?
Sinusitis usually gets better on its own, but if your symptoms are very bad and last for more than a week, it's worth seeing your doctor. If you feel very ill with sinus problems, and also have a high temperature, you are still likely to be given antibiotics.
If your symptoms are mild, research shows that a steroid spray may help. Over-the-counter painkillers such as paracetamol or ibuprofen can be used to relieve the pain. You could also try inhaling warm, moist air, such as when you take a bath, to help clear blocked sinuses, although inhaling steam is not advised because of the risk of scalding. You could also try a decongestant nasal spray for symptom relief, although there's no good research on whether these sprays work or not for sinusitis. Decongestant sprays should not be used for longer than a week.
From:
Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. Journal of the American Medical Association. 2007; 298: 2487-2496.
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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
