New Study: Antibiotics, Steroids No Better Than Placebo for Acute Sinusitis

[Steven L.]

Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07

TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.

"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."

"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.

But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.

"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.

But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.

According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.

Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.

"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.

For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.

In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.

In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.

The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.

As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.

"It's difficult to make a distinction in a primary-care setting," Baugh
said.

http://tinyurl.com/3269q7

[
Here's a link to the JAMA paper if you want to pay for it:

http://jama.ama-assn.org/cgi/content/full/298/21/2543

I disagree that there is no way to tell if the infection is viral or
bacterial. There is an easy way to tell: Viral infections tend to be
self-limiting. If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.

That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. Wait a good 3 or 4 weeks and
then see how it's doing. It may start to clear by then.
]

[Fred]

Post by Steven L.
Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.
"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.
Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.
In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.
As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baugh
said.
http://tinyurl.com/3269q7
[
http://jama.ama-assn.org/cgi/content/full/298/21/2543
I disagree that there is no way to tell if the infection is viral or
bacterial. �There is an easy way to tell: �Viral infections tend to be
self-limiting. �If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.
That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. �Wait a good 3 or 4 weeks and
then see how it's doing. �It may start to clear by then.
]
--
Steven L.
Remove the NOSPAM before replying to me.

I just think that you need to keep the nasal membranes from excreting
excessive mucus. This excessive mucus is the breeding ground for both
bacteria and viruses. If you can keep the mucus flow to a minimum,
you will have healthier sinuses. This means getting control of nasal
inflammations.

[Fred]

Post by Steven L.
Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.
"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.
Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.
In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.
As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baugh
said.
http://tinyurl.com/3269q7
[
http://jama.ama-assn.org/cgi/content/full/298/21/2543
I disagree that there is no way to tell if the infection is viral or
bacterial. �There is an easy way to tell: �Viral infections tend to be
self-limiting. �If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.
That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. �Wait a good 3 or 4 weeks and
then see how it's doing. �It may start to clear by then.
]
--
Steven L.
Remove the NOSPAM before replying to me.

To get control of my sinus problems I used both a steroid and a drying
agent. It makes sense. If you have a minor inflammation, use a
steroid to help heal the interior of your nose. Then, concurrently,
use a drying agent like Ipratropium Bromide to dry up the running
nose. You are affecting the smooth muscle on the inside of your
nose. I also used a nasal lavage to keep the insides of my nose
clean. I still have minor drainage. If the nose runs too much, I
just take a little more Ipratropium Bromide to dry up the unwanted
mucus.

[judy.n]

Steven,
All the clinical guidelines talk about treating severe symptoms: so
for many of us with deranged anatomy, thanks to surgery, we get very
ill, very quickly. When I get a bad sinusitis, there is simply no way
I could wait 3 weeks.
So, clinical judgement is important.
For the average, healthy person, waiting will usually work.
I like the fact that the editorial admitted that no clear clinical
indications will determine whether sinusitis is viral or bacterial--
and it's usually multifactoral, as the virus causes initial
inflammation and destruction of cilia, and then the bacteria move in:
hence the "double sickening". And, patients with immunodeficiencies,
prior or recent surgery, or severe disease should be treated.
To quote your editorial:
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell ..."
Judy

Post by Steven L.
Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.
"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.
Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.
In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.
As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baugh
said.
http://tinyurl.com/3269q7
[
http://jama.ama-assn.org/cgi/content/full/298/21/2543
I disagree that there is no way to tell if the infection is viral or
bacterial. There is an easy way to tell: Viral infections tend to be
self-limiting. If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.
That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. Wait a good 3 or 4 weeks and
then see how it's doing. It may start to clear by then.
]
--
Steven L.
Remove the NOSPAM before replying to me.

[n***@yahoo.com]

Post by judy.n
Steven,
All the clinical guidelines talk about treating severe symptoms: so
for many of us with deranged anatomy, thanks to surgery, we get very
ill, very quickly. When I get a bad sinusitis, there is simply no way
I could wait 3 weeks.
So, clinical judgement is important.
For the average, healthy person, waiting will usually work.
I like the fact that the editorial admitted that no clear clinical
indications will determine whether sinusitis is viral or bacterial--
and it's usually multifactoral, as the virus causes initial
hence the "double sickening". And, patients with immunodeficiencies,
prior or recent surgery, or severe disease should be treated.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell ..."
Judy

Another possible approach ... one that /I/ had to raise with Mayo's
ENT (he reacted as though I'd just invented the notion):

Culture early. Treat late.

He thought it was a swell idea. I've /never/ had a culture to see
what bug was making my sinuses sick. Have any of you?

From my paltry knowledge, they've figured out ways to figure out what
bug is ailing you, particularly whether it's bacterial, fungal, or
viral.

From my paltry knowledge, they've decided that each merits distinctly
different treatment methods.

From my paltry knowledge, some don't particularly respond to treatment
at all, but resolve with time.

From my paltry knowledge, there are NARROW-spectrum ABX that can be
used to treat particular strains of particular bacteria, possibly more
quickly, more cheaply, and with less resistance and deleterious
effects on overall health.

So, I asked, any downside to /culturing/ immediately, but then Rx'ing
NOTHING until the results were back?

Swell idea, he thought.

Did I just invent the wheel, or something???? Not to my way of
thinking ... or ... hoping.

[rpautrey2]

If they aren't effective for acute sinusitis they certainly couldn't
be effective for chronic sinusitis. See my "Sinus Drainage Methods"
post in this group. My solution is probably the only solution. Paul

Post by Steven L.
Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.
"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.
Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.
In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.
As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baugh
said.
http://tinyurl.com/3269q7
[
http://jama.ama-assn.org/cgi/content/full/298/21/2543
I disagree that there is no way to tell if the infection is viral or
bacterial. There is an easy way to tell: Viral infections tend to be
self-limiting. If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.
That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. Wait a good 3 or 4 weeks and
then see how it's doing. It may start to clear by then.
]
--
Steven L.

[judy.n]

I just read the study and editorial: lousy study: done over 4
years( 2001-2005) with an average of one patient per practice
recruited, with lousy clinical guidelines, only a 65% chance at best
that the patients had bacterial sinusitis. So, if almost half, or more
of the patients had viral illness, of course antibiotics made no
difference.
The editorial cited poor methods and selection bias, and concluded
that judicious prescribing of antibiotics was indicated in acute
sinusitis.
They were looking at methods to predict who is really sick and one
study looked at HS-CRP and improved symptoms with penicillin.
So, this study is garbage: read it--even the abstract--not the news
coverage.
Judy

Post by rpautrey2
If they aren't effective for acute sinusitis they certainly couldn't
be effective for chronic sinusitis. See my "Sinus Drainage Methods"
post in this group. My solution is probably the only solution. Paul

Post by Steven L.
Sinusitis Treatments Found Ineffective
British study reports antibiotics and nasal steroids don't lessen symptoms
By Amanda Gardner
Posted 12/4/07
TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work
no better than a placebo in combating sinus infections, a new British
study shows.
"Antibiotics are probably not as effective as have been previously
believed, particularly for the majority of cases of acute sinusitis,"
said study author Dr. Ian Williamson, a senior lecturer in primary
medical care at the University of Southampton. "Patients should turn
more to symptomatic remedies like analgesics while the body heals
itself, usually over a period of three days to three weeks. Topical
steroids have little overall effect, but may be beneficial, particularly
in milder cases of acute sinusitis."
"For sinusitis, however it is being diagnosed in the primary-care
setting, many of these cases do not require treatment, and a more
cautious and conservative approach would seem to be warranted," added
Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center
College of Medicine and director of the division of otolaryngology at
Scott & White, in Temple, Texas.
But other experts say the study, published in the Dec. 5 issue of the
Journal of the American Medical Association, is no reason to scrap
antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn
antibiotics in those people who need them," said Dr. Michael Stewart,
chairman of the department of otolaryngology at New York
Presbyterian-Weill Cornell Medical Center, in New York City.
But, he added, only a minority of sinus infections are bacterial and
will respond to antibiotics. The majority are viral infections, which
won't respond to antibiotics.
According to an accompanying editorial, sinus problems account for 25
million doctor's office visits in the United States each year.
Antibiotics are used to treat sinus infections 85 percent to 98 percent
of the time in the United States.
Overuse of antibiotics not only won't help a patient with a viral
infection get better, it will contribute to the growing problem of
antibiotic resistance, experts have noted.
"Antibiotic resistance is rising dramatically, and there is no question
about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one
of four treatment groups: 500 milligrams of the antibiotic amoxicillin
three times a day for seven days plus 200 micrograms of the nasal
steroid budesonide once a day for 10 days; a placebo in place of the
antibiotic plus budesonide; amoxicillin plus a placebo in place of
budesonide; or two placebos.
In the amoxicillin group, 29 percent of patients had symptoms lasting at
least 10 days, and 33.6 percent of those not receiving amoxicillin had
the same symptom length of time.
In both the budesonide and no-budesonide groups, exactly 31.4 percent of
patients had symptoms lasting at least 10 days.
The nasal steroids seemed to be more effective in individuals who had
less severe symptoms.
As the editorial pointed out, most patients with acute sinusitis will
get better on their own. Unfortunately, there's no good way to determine
who has viral sinusitis and who has bacterial sinusitis.
"It's difficult to make a distinction in a primary-care setting," Baugh
said.
http://tinyurl.com/3269q7
[
http://jama.ama-assn.org/cgi/content/full/298/21/2543
I disagree that there is no way to tell if the infection is viral or
bacterial. There is an easy way to tell: Viral infections tend to be
self-limiting. If you're still sick after 3 weeks, and the infection
may even be getting worse, than it's probably not viral.
That's why I suggest that if you have acute sinusitis, resist the
temptation to see your doctor right away. Wait a good 3 or 4 weeks and
then see how it's doing. It may start to clear by then.
]
--
Steven L.

[Steven L.]

Post by judy.n
I just read the study and editorial: lousy study: done over 4
years( 2001-2005) with an average of one patient per practice
recruited, with lousy clinical guidelines, only a 65% chance at best
that the patients had bacterial sinusitis.

But that is typical of what primary-care physicians deal with. That is
the realistic situation.

Primary-care physicians are not set up to do cultures and determine if
there is a bacterial infection. They usually just prescribe antibiotics
for a patient based on symptoms. Patients are not referred to an ENT
until they start getting recurrent or chronic sinus infections.

So this study is suggesting that primary-care physicians should not
continue to throw antibiotics at the problem as they have been doing up
to now.

[judy.n]

You reached a false conclusion: the study used CLINICAL guidelines
that were flawed, and no one realistically only treats endoscopically
obtained cultures, they treat patients clinically. All the
Otolaryngology guidelines are based on clincial symptoms. So, as a
clinician, if you use your judgement, listen carefully to the history,
judge the severity of the illness, and understand how to apply
clinical guidelines, you should prescribe antibiotics "judicicously":
more and more, we use delayed prescriptions--and the article quoted
that in England, where this is widely utilized, only 30% of patients
picked up their antibiotics. You give the patient a prescription, and
tell them that if things are getting worse: focal pain, fever,
systemic symptoms, fill the script. Amazing how most patients are
pretty accurate judges of the course and severity of their illness.
Sinusitis is a clinical diagnosis: all imaginig is imperfect and
endoscopically obtained cultures are rarely even utilized by ENT's who
have the technology--only in resistant and/or persistant cases.
In this study, the patients had to present with a single episode of
non-recurrent "sinusitis". One episode. And the guidelines were one
sided nasal discharge, and a few other symptoms that have been shown
to have low predicitive value.
I'll post the abstract.
Judy

Post by Steven L.

Post by judy.n
I just read the study and editorial: lousy study: done over 4
years( 2001-2005) with an average of one patient per practice
recruited, with lousy clinical guidelines, only a 65% chance at best
that the patients had bacterial sinusitis.

But that is typical of what primary-care physicians deal with. That is
the realistic situation.
Primary-care physicians are not set up to do cultures and determine if
there is a bacterial infection. They usually just prescribe antibiotics
for a patient based on symptoms. Patients are not referred to an ENT
until they start getting recurrent or chronic sinus infections.
So this study is suggesting that primary-care physicians should not
continue to throw antibiotics at the problem as they have been doing up
to now.
--
Steven L.
Remove the NOSPAM before replying to me.

[judy.n]

Here's the pubmed link to the abstract:
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18056902&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Comment in:
JAMA. 2007 Dec 5;298(21):2543-4.
Antibiotics and topical nasal steroid for treatment of acute maxillary
sinusitis: a randomized controlled trial.

Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, Little
P.
Department of Medicine, University of Southampton, Southampton,
England. ***@soton.ac.uk
CONTEXT: Acute sinusitis is a common clinical problem that usually
results in a prescription for antibiotics but the role of antibiotics
is debated. Anti-inflammatory drugs such as topical steroids may be
beneficial but are underresearched. OBJECTIVE: To determine the
effectiveness of amoxicillin and topical budesonide in acute maxillary
sinusitis. DESIGN, SETTING, AND PATIENTS: A double-blind, randomized,
placebo-controlled factorial trial of 240 adults (aged > or =16 years)
with acute nonrecurrent sinusitis (had > or =2 diagnostic criteria:
purulent rhinorrhea with unilateral predominance, local pain with
unilateral predominance, purulent rhinorrhea bilateral, presence of
pus in the nasal cavity) at 58 family practices (74 family physicians)
between November 2001 and November 2005. Patients were randomized to 1
of 4 treatment groups: antibiotic and nasal steroid; placebo
antibiotic and nasal steroid; antibiotic and placebo nasal steroid;
placebo antibiotic and placebo nasal steroid. INTERVENTION: A dose of
500 mg of amoxicillin 3 times per day for 7 days and 200 mug of
budesonide in each nostril once per day for 10 days. MAIN OUTCOME
MEASURES: Proportion clinically cured at day 10 using patient symptom
diaries and the duration and severity of symptoms. RESULTS: The
proportions of patients with symptoms lasting 10 or more days were 29
of 100 (29%) for amoxicillin vs 36 of 107 (33.6%) for no amoxicillin
(adjusted odds ratio, 0.99; 95% confidence interval, 0.57-1.73). The
proportions of patients with symptoms lasting 10 or more days were 32
of 102 (31.4%) for topical budesonide vs 33 of 105 (31.4%) for no
budesonide (adjusted odds ratio, 0.93; 95% confidence interval,
0.54-1.62). Secondary analysis suggested that nasal steroids were
significantly more effective in patients with less severe symptoms at
baseline. CONCLUSION: Neither an antibiotic nor a topical steroid
alone or in combination was effective as a treatment for acute
sinusitis in the primary care setting. TRIAL REGISTRATION: isrctn.org
Identifier: ISRCTN60825437.
PMID: 18056902 [PubMed - indexed for MEDLINE]

Again, you should read the editorial: this is a flawed study, but it
sure got a lot of press: 240 patients divided into 4 groups: that's 60/
group, over the course of 4 years. Underpowered, and the clinical
criteria have a low predictive value.

But the press is all over it, and no one takes the time to actually
look at the study.
Judy

Post by judy.n
You reached a false conclusion: the study used CLINICAL guidelines
that were flawed, and no one realistically only treats endoscopically
obtained cultures, they treat patients clinically. All the
Otolaryngology guidelines are based on clincial symptoms. So, as a
clinician, if you use your judgement, listen carefully to the history,
judge the severity of the illness, and understand how to apply
more and more, we use delayed prescriptions--and the article quoted
that in England, where this is widely utilized, only 30% of patients
picked up their antibiotics. You give the patient a prescription, and
tell them that if things are getting worse: focal pain, fever,
systemic symptoms, fill the script. Amazing how most patients are
pretty accurate judges of the course and severity of their illness.
Sinusitis is a clinical diagnosis: all imaginig is imperfect and
endoscopically obtained cultures are rarely even utilized by ENT's who
have the technology--only in resistant and/or persistant cases.
In this study, the patients had to present with a single episode of
non-recurrent "sinusitis". One episode. And the guidelines were one
sided nasal discharge, and a few other symptoms that have been shown
to have low predicitive value.
I'll post the abstract.
Judy

Post by Steven L.

Post by judy.n
I just read the study and editorial: lousy study: done over 4
years( 2001-2005) with an average of one patient per practice
recruited, with lousy clinical guidelines, only a 65% chance at best
that the patients had bacterial sinusitis.

But that is typical of what primary-care physicians deal with. That is
the realistic situation.
Primary-care physicians are not set up to do cultures and determine if
there is a bacterial infection. They usually just prescribe antibiotics
for a patient based on symptoms. Patients are not referred to an ENT
until they start getting recurrent or chronic sinus infections.
So this study is suggesting that primary-care physicians should not
continue to throw antibiotics at the problem as they have been doing up
to now.
--
Steven L.
Remove the NOSPAM before replying to me.

[Steven L.]

Post by judy.n
You reached a false conclusion: the study used CLINICAL guidelines
that were flawed, and no one realistically only treats endoscopically
obtained cultures, they treat patients clinically. All the
So, as a
clinician, if you use your judgement, listen carefully to the history,
judge the severity of the illness, and understand how to apply
more and more, we use delayed prescriptions--and the article quoted
that in England, where this is widely utilized, only 30% of patients
picked up their antibiotics. You give the patient a prescription, and
tell them that if things are getting worse: focal pain, fever,
systemic symptoms, fill the script. Amazing how most patients are
pretty accurate judges of the course and severity of their illness.

That's fine, but that's NOT how it's typically done in America. That's
my point.

In America, a patient will go to the primary-care doctor and demand to
be cured immediately because he or she has an important job and can't
afford to call in sick. The family physician will prescribe the
antibiotic "just in case" the infection might be bacterial, and the
patient will start on it immediately. Another common scenario: A
desperate mom will demand immediate antibiotic treatment for her
asthmatic child, to try to prevent that midnight trip to the ER when the
child gets an infection-triggered asthma attack.

(In fact, when I was a kid, antibiotics were even commonly prescribed
for the *common cold*, ostensibly to try to prevent secondary bacterial
infection. That's not done much anymore, fortunately.)

In America, antibiotics are majorly over-prescribed by primary-care
physicians and taken by patients for many illnesses without waiting a
couple of weeks to see if improvement is spontaneous. There will be a
subgroup of patients who, for whatever reason, will worsen with time.
But they should be examined again in that case, to rule out the onset of
bronchitis, pneumonia, meningitis, etc.

Post by judy.n
In this study, the patients had to present with a single episode of
non-recurrent "sinusitis". One episode.

But again, that's typical. And the recommendation is correct: If this
is the patient's first bout with a condition whose symptoms resemble
sinusitis, the best treatment is *symptomatic* in the vast majority of
cases. In that sense, it's no different from how you treat a common
cold--because in fact, they're often two sides of the same coin.

As for the study symptomatology having low predictive value, the real
issue for this study is not its predictive value but its *relevance*--is
this the way the majority of primary-care physicians in America have
attempted to diagnose sinusitis? The answer is yes, it is, as I can
attest from personal experience. If you want to suggest that
primary-care physicians should diagnose sinusitis with other more
reliable criteria, that's a whole other study you could cite them.

This study really does seem to capture the *essence* of how acute
nonrecurrent sinusitis is treated (or mistreated) by primary-care
physicians here in America. And if they continue to do things that way,
then the conclusion from this study is that they are better off doing
nothing at all than throwing antibiotics at what they have diagnosed (or
misdiagnosed) to be the problem. A conclusion with which I heartily agree.

[rpautrey2]

PA!!!

Post by Steven L.
This study really does seem to capture the *essence* of how acute
nonrecurrent sinusitis is treated (or mistreated) by primary-care
physicians here in America. And if they continue to do things that way,
then the conclusion from this study is that they are better off doing
nothing at all than throwing antibiotics at what they have diagnosed (or
misdiagnosed) to be the problem. A conclusion with which I heartily agree.
--
Steven L.
Remove the NOSPAM before replying to me.

[23x]

Sinusitis Treatments Found Ineffective

British study reports antibiotics and nasal steroids don't lessen symptoms