Antibiotics are unlikely to help sinusitis

Sinus infections are among the most common and aggravating medical conditions, diagnosed in around 31 million Americans each year. And for most patients, treatment has long included an antibiotic.

Now, medical experts are pushing for a less-aggressive approach. Around 21 percent of antibiotic prescriptions for adults in the U.S. are for sinusitis, even though studies show the drugs often do little or no good. Short-term sinusitis can be caused by either a bacterial infection, which may respond to treatment with antibiotics, or a viral infection, which doesn't. Doctors believe the overwhelming majority of cases begin as viral infections, and less than 2 percent of those turn into bacterial infections.

The American Academy of Otolaryngology - Head and Neck Surgery, which represents ear, nose and throat specialists, issued new guidelines last year for treating sinusitis. Among these: Doctors generally should wait 10 days before even considering an antibiotic. If the sinus sufferer is feeling better by then, the bug is almost surely a virus, and antibiotics would be of no use.

But if the problem lasts more than 10 days, chances are good it is bacterial. At this point, if the patient's illness is relatively mild, the guidelines leave it up to the doctor to decide between prescribing an antibiotic or monitoring the patient for as much as another week.

Some patients, and their doctors, might not be willing to wait. Keisha Herbin Smith knew what she wanted when she called her doctor's office last month about symptoms including congestion, a headache and a runny nose. Ms. Herbin Smith, a 30-year-old research coordinator from Woodbridge, Va., asked the nurse for an antibiotic to head off a full-blown sinus infection, so it wouldn't ruin a long-planned weekend at the beach. An antibiotic "just makes you feel better sooner," says Herbin Smith, who got her prescription and enjoyed her vacation, and later went to see her doctor when she returned.

The drugs have drawbacks. The analysis's lead author, Richard Rosenfeld, found that 25 percent of sinusitis patients who got antibiotics had side effect such as gastrointestinal problems, skin rashes or headaches. Widespread use of antibiotics is also blamed for the emergence of resistant bacteria that don't respond to traditional drugs.

Other medical authorities want to go even further than the academy's guidelines to minimize the use of antibiotics in treating sinusitis. An analysis by international researchers published in the Lancet medical journal in March said the drugs "are not justified even if a patient reports symptoms for longer than seven to 10 days." That's because the way doctors typically diagnose sinusitis, based on symptoms, isn't typically enough to determine which patients will benefit from antibiotics, the authors concluded.

Bonnie - we have discussed the overuse of antibiotics for years. Here is yet another case of it. Mayo Clinic research also determined that many sinus infections are fungal in nature (i.e. yeast overgrowth). Antibiotics actually worsen this situation making the fungi stronger and more antibiotic resistant.