Sinusitis: You can get a print of this, suitable for framing, by writing the Mayo Clinic.

The Washington Post (2/15, Huget) “The Checkup” blog reports, “A study released Tuesday adds to the growing body of science suggesting that with some infections, including those of the sinuses, antibiotics aren’t the best course of treatment.” Investigators found “that in their study of 166 adults with sinus infections, those who were given the antibiotic amoxicillin didn’t feel better any faster than those who received a placebo. People in both groups experienced about the same amount of relief after three days.” The study is published in the Journal of the American Medical Association.

Bloomberg News (2/15, Ostrow) adds, “One in five antibiotic prescriptions in the US are given to adults for sinus infections, the authors wrote. The findings suggest doctors avoid routine antibiotic treatment for patients with an uncomplicated sinus infection, they said in the study.”

Medscape (2/15, Brown) reports, “‘Considering the public health threat posed by increasing antibiotic resistance, strong evidence of symptom relief is needed to justify prescribing of antibiotics for this usually self-limiting disease,’ the authors write.”

“CDC guidelines for the evaluation and treatment of adults with sinusitis…suggested that doctors only prescribe antibiotic treatment for the condition when patients have moderately severe or severe symptoms,” WebMD (2/15, Broder) notes.

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC.  This post is from 2013, but is still valid.

It has been known for over fifty years that most upper respiratory infections  (URI’s) are due to viruses and not bacteria.  Why is that important?  Because viruses do not respond to antibiotics, while bacteria do.  When I went to med school they taught us to rule out Strep throat (the cause of rheumatic heart disease) with a throat culture and treat with penicillin if positive.

If the  culture was negative, and since most URI’s are viral, we were encouraged to withhold antibiotics and treat with decongestants, humidifiers and analgesics.  Then, if signs of bacterial overgrowth were to develop later (e.g. a bronchitic cough, discolored sputum, fever, signs of pneumonia, etc.) then an antibiotic could be added.  The main reason why everyone with a URI should not get antibiotics is because of concern about a major public health problem—antibiotic resistance.

Many patients with URI’s involving the nose and throat also have sinusitis, which is one of the most common conditions that doctors treat. It is very uncomfortable, and patients expect doctors to give antibiotics—most do.  The study above shows that for patients with uncomplicated rhinosinusitis (rhino refers to your nose), antibiotics do not reduce symptoms better than placebo.  About 70% of cases will subside spontaneously.  The study was done using a special questionnaire called SNOT-16. Who says doctors have no sense of humor?

Even if bacteria are present in the sinuses, antibiotics may not work, because the sinuses are closed spaces with limited drainage; good drainage is an essential aspect of curing infections. Complicated and/or recurrent sinus infections can be difficult to treat, and ENT docs have a variety of approaches to such cases.

But if you have a “common cold” with or without an element of sinus infection, the problem usually will resolve without antibiotics. If you are sick, let your doctor decide.

ADELAIDE’S  LAMENT..from Guys and Dolls: