Antibiotics Overprescribed For Sinusitis?

Studies Suggest Only Small Percent Of Acute Sinus Infections Respond To Antibiotic Treatment

(WebMD)  Antibiotics are still being widely overprescribed for sinusitis, though the majority of these illnesses are caused by viruses, new research shows.

Studies suggest that only about 3 percent to 5 percent of acute sinus infections are bacterial in nature, meaning that they respond to antibiotic treatment.

Using data derived from two national studies of prescription practices,
researchers concluded that antibiotics were prescribed for slightly more than four out of five patients with acute sinusitis and two-thirds of patients with chronic sinusitis.

"By the current guidelines it does appear that antibiotics are being overused," study researcher Donald A. Leopold, MD, tells WebMD. "This may be
due to the fact that we feel the need to give patients something and there are not a lot of effective treatments. And it could be that antibiotics really do help patients feel better."

Antibiotics Prescribed Most Often

Rhinosinusitis is an inflammation of the nasal passageway and sinus cavities. Symptoms are considered acute when they last up to four weeks and
chronic when they persist for three months or longer.

Acute sinusitis is usually caused by viral infections. The causes of chronic
sinusitis are not as well understood, but they are thought to be driven by
inflammation.

Though there has been a general feeling that antibiotics are overprescribed
in the treatment of sinus infections and other sinus-related illness, little
research has been done to confirm this.

In the newly published study, Leopold, Hadley J. Sharp, and colleagues from
the University of Nebraska Medical Center examined data from two National
Center for Health Statistics surveys assessing prescribing practices for sinus infections in physicians' offices and hospital ERs.

The surveys were conducted between 1999 and 2002, and they included roughly
14.2 million health care visits for chronic sinus infections and 3.1 million
visits for acute sinus issues during the time period.

The most widely prescribed treatments for both acute and chronic sinus
infections were antibiotics, followed by antihistamines, nasal decongestants, inhaled corticosteroids, and expectorants and other antimucus agents.

Penicillins were the most commonly prescribed antibiotics, followed by
cephalosporins — another class of antibiotics. Antibiotics were prescribed 70 precent of the time during health care visits for chronic sinus infections and 83 percent of the time for acute sinus infections.

"The vast use of [antibiotics] makes the statement that they seem to be
effective in reducing symptoms or preventing relapse, or they would have been abandoned," Leopold and colleagues write. "Another important possibility is that many patients have self-limited disease that will resolve regardless of treatment, and their physicians could be prescribing what they think will work."

Inhaled Steroids and Saline Sprays

Ear, nose, and throat specialist Michael Benninger, MD, tells WebMD that the
overprescribing of antibiotics is largely driven by patient expectations.

He points out that in Europe, antibiotics are rarely prescribed for sinus
infections.

"In this country, I really don't think we have gotten to the point where we
tell patients they don't need antibiotics."

Benninger adds that he is somewhat surprised by the latest findings, given
the concerns about antibiotic overuse spurring resistance to the drugs.

"The bottom line is we should not be treating a virus with an antibiotic,
and we should not assume that antibiotics are the best treatment for acute or chronic rhinosinusitis," he says.

Inhaled steroids, used to reduce inflammation, appear to be a better
approach for many patients with chronic sinus problems, he adds.

But this treatment was prescribed only 16.4 percent of the time to patients in the study with chronic symptoms.

Leopold and Benninger agree that one of te best treatments for nonbacterial
acute sinus infections is also one of the simplest.

Flushing the nose frequently with a saline nasal spray is a highly effective, over-the-counter therapeutic approach, Leopold says. He recommends that patients start using saline sprays when they feel upper respiratory symptoms coming on.

"My patients are sick of hearing about this, but saline therapy is cheap,
effective, and underutilized," he says.

[momsbattle]

My son suffers horribly with sever sinus infections; he is only 4 years of age. This last infection he has topped all the rest, he is in so much pain telling me his head hurts and that he is extremely dizzy. We have been to the hospital, Pediatrician, and a ENT specialist and no one has helped him. Other then prescribing Antibiotics, it appears that is the answer with every infection he has so he is on Antibiotics at least every 4 months for his sunus problems. Can anyone recommend anything other then the saline sprays, as I can only get that into him twice a day if I am lucky.

[ka5biw]

Please continue the story. Tell people that saline sprays are a good treatment for sinus problems. The virus doesn't cause the pain. The lack of drainage is what causes the pain. Also, why not tell folks that clear discharge indicates virus and those wonderful colours throughout the day indicate bugs. Some of us who have chronic sinus problems have become educated and only head for the doctor when we have tried everything else listed in the report. We then have troubles convincing the Physician's Assistant that it is time for the antibiotics. Mere sinus problems are not treated by real doctors any longer. Personally, I only get about one really nasty sinus infection each year. Then, because of the poor diagnostic skills of the Physician's Assistants, it can take a couple of months to get rid of the infection. I usually have to get very nasty with the front desk to get scheduled with an M.D. The M.D. usually takes care of the problem.

[cgesualdo]

ka5biw - why are you still going to this particular doctor if you can't get in to see the actual doctor when you request it? Time to find a doctor who cares about his/her patients.

I have the same problem, sort-of. I've had constant sinus problems for the last four years and counting. The one thing my doctor does not do is prescribe antibiotics. But she's not prescribing anything that really works either. I guess I'm just doomed to suffer. (By the way, I AM using the saline rinse, which does seem to help somewhat.)

[ka5biw]

Please continue the story. Tell people that saline sprays are a good treatment for sinus problems. The virus doesn't cause the pain. The lack of drainage is what causes the pain. Also, why not tell folks that clear discharge indicates virus and those wonderful colours throughout the day indicate bugs. Some of us who have chronic sinus problems have become educated and only head for the doctor when we have tried everything else listed in the report. We then have troubles convincing the Physician's Assistant that it is time for the antibiotics. Mere sinus problems are not treated by real doctors any longer. Personally, I only get about one really nasty sinus infection each year. Then, because of the poor diagnostic skills of the Physician's Assistants, it can take a couple of months to get rid of the infection. I usually have to get very nasty with the front desk to get scheduled with an M.D. The M.D. usually takes care of the problem.