Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile

Jane M. Garbutt, MBChB, of Washington University in St. Louis and colleagues found that for most cases of acute sinusitis, antibiotics do not relieve symptoms. (Image: Richard Fair)

About 1 in 5 antibiotic prescriptions given to US adults is for treatment of sinusitis, but in most cases, the medication does not provide symptom relief for the condition, suggests study findings appearing today in JAMA.

In the study, researchers from Washington University School of Medicine in St Louis randomly assigned 85 adults with uncomplicated acute sinusitis to receive a 10-day course of amoxicillin (1500 mg per day) and 81 adults to receive a placebo. At days 3 and 10, the researchers found no difference between the groups in improved disease-specific quality of life or symptom relief. The researchers note that their findings support recommendations to avoid routinely prescribing antibiotics for patients with uncomplicated acute sinusitis, as such treatment does not improve their condition and may add to the public health threat of antibiotic resistance.

Lead author Jane M. Garbutt, MBChB, of the division of general medical sciences at Washington University, discusses her team’s findings:

Sinusitis, infection of the paranasal sinuses, usually occurs as a result of a viral infection and can cause nasal obstruction, pain in the face, nasal discharge, cough, sore throat, and fatigue. (Image: JAMA, ©AMA)

“In most cases, sinusitis develops after a cold, and this viral infection will be complicated by a bacterial infection—which can respond to antibiotic therapy—in less than 5% of cases. For primary care physicians, it’s important to identify which patients have a bacterial infection versus a viral infection.

“The expectations that antibiotics will benefit sinusitis is something we [in the medical profession] need to tackle overall and preferably not when seeing a sick patient. A lot of the time, patients call in and say they have a sinus infection and need an antibiotic, and the physician will call in the prescription without even having a conversation with the patient. Also, almost 90% of patients who go to the physician’s office with sinusitis will walk out with a prescription for antibiotics.

“Delayed prescription might help this situation: After the physician sees or has a conversation with the patient and makes the diagnosis of acute sinusitis, the physician [can] explain the condition is most likely viral and that in 10 days the patient will be better. Then the physician should say, ‘I will give you the prescription, but I don’t think an antibiotic will help today. If things don’t improve after 5 or 7 days, then fill the prescription because the chances of [the infection] being bacterial are increased.’”

Categories: Bacterial Infections, Drug Therapy, Primary Care/Family Medicine, Viral Infections