When Trouble Hits Those Holes in Your Head
Doctors are advised to use antibiotics to treat sinusitis when at least three of four signs are present: purulent (yellowish or greenish) nasal discharge predominantly on one side, local facial pain mainly on one side, purulent nasal discharge on both sides or pus in the nasal cavity.
Many physicians as well as patients take purulent nasal discharge lasting seven or more days as the primary indication of a bacterial sinus infection. Yet, study after careful study has shown no reliable benefit of antibiotics when doctors try to apply this or any of the other criteria in deciding on drug treatment.
In the latest study, published last month in The Journal of Family Practice, no significant benefit over a placebo was found from using the antibiotic amoxicillin among 135 patients with typical indications of a sinus infection. All the patients complained of sinusitis, with pus in the nasal cavity, facial pressure or nasal discharge lasting longer than seven days.
A small subgroup of patients receiving the antibiotic became better faster than the others. But the researchers were unable to discern anything about those patients in advance of treatment that indicated a bacterial infection, as opposed to a viral one.
That does not mean that antibiotics are useless in treating sinusitis. But it does mean more research is needed to help doctors determine who is most likely to benefit from the costly and potentially harmful drugs.
But all of my patients KNOW that antibiotics are necessary. And we (most primary care physicians) provide antibiotics to these patients, despite uncertain data on their efficacy.
