Most people with sinusitis don't benefit from antibiotics
Publication Date:17/03/2008
Most people who get sinusitis don't benefit from antibiotics, a new study suggests. Doctors sometimes prescribe antibiotics for people who have sinusitis that's lasted longer than a week. But these people are no more likely to benefit from antibiotics than anyone else, the study says. People with sinusitis usually get better on their own.
What do we know already?
Sinusitis can be very painful, causing a bad headache, pain in the cheeks and forehead, and large amounts of mucus from the nose. It happens when air pockets in the skull (the sinuses) become inflamed. Sinusitis is often caused by an infection with bacteria or viruses.
Up to 9 in 10 people who get sinusitis are prescribed antibiotics. But doctors aren't sure whether treatment is always necessary. Antibiotics only work against bacteria, but many cases of sinusitis are caused by a virus. There's no easy way for doctors to tell whether a particular case of sinusitis is caused by bacteria or a virus. As a rough guide, advice for doctors suggests prescribing antibiotics for people who've had sinusitis lasting longer than seven days.
More and more, doctors are trying not to prescribe antibiotics unless people really need them. Using antibiotics too much can mean bacteria become resistant 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 now combined the results from several good-quality trials, trying to see if there's a way for doctors to spot the people with sinusitis who are likely to benefit from antibiotics.
What does the new study say?
The study found that, most of the time, there's no easy way for doctors to tell who might benefit from antibiotics. Even if someone has had sinusitis for longer than seven days, the researchers say antibiotics can't be justified. Treatment with antibiotics could cause side effects, and lead to bacteria becoming resistant and harder to treat in future.
The researchers did find that people with a phlegm-like discharge from their throat seemed more likely to benefit from antibiotics. These people also took longer to cure.
Tell me more about the study's findings
The study looked at the results from nine other studies, which included 2,640 people. All of them had sinusitis. Half were treated with antibiotics while the other half were given dummy tablets (a placebo).
People with sinusitis usually got better on their own. Overall, the study found that 6 in 10 people got better in 14 days without antibiotics. Antibiotics only made a small difference. The study found that 15 people would need to take antibiotics for 1 person to benefit.
People who were older or who had more severe symptoms took longer to get better. But antibiotics were no likely to help them these people than anyone else.
Where does the study come from?
The study was done by researchers from the University Hospital in Basel, Switzerland. It appeared in a medical journal called The Lancet, which is published by a company called Elsevier.
How reliable are the findings?
This was a good study. It included lots of people and was well done. But it did combine the results from lots of other studies, and there were differences in the way those studies did things. For example, people took different antibiotics. This makes the results slightly less reliable.
What does this mean for me?
In the past, doctors often prescribed antibiotics for sinusitis. But more and more research has suggested that most people won't be helped by antibiotics. If you see your doctor with sinusitis, he or she might suggest a wait-and-see approach, to see how you get on without antibiotics.
This study only looked at adults who were generally healthy. The findings don't apply to children and people with a weak immune system.
What should I do now?
If you get sinusitis, you shouldn't always expect your doctor to give you antibiotics. As an alternative, some doctors write a prescription for antibiotics and suggest 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.
There are also some other things you can try. Painkillers, such as paracetamol or ibuprofen, may help you feel better. You can also try breathing in water vapour, by sitting over a bowl of warm water or taking a hot bath. But take care not to scald yourself.
Research shows that a steroid spray may help with sinusitis. You could also try a decongestant nasal spray, although there's no good research on whether these sprays work for sinusitis. Decongestant sprays shouldn't be used for longer than a week.
Occasionally, sinusitis can be linked to a severe infection. Antibiotics are still recommended for people who are very ill with a high temperature, swelling around their eyes, red skin and severe pain in the face.
From:
Young J, De Sutter A, Merenstein D, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. The Lancet. 2008; 371: 908-914.
To learn more, see our information on sinusitis.
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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.
