Antibiotics Useless for Most Sinus Infections, Experts Say
WEDNESDAY, March 21 (HealthDay News) -- Most sinus infections are caused
by viruses and should
not be treated with antibiotics, which target bacteria and are useless against
viruses, new expert guidelines state.
About 14 percent (one in seven) of people are diagnosed with a sinus infection
each year, and sinus infections remain the fifth leading reason for antibiotic
prescriptions. However, between 90 percent and 98 percent of the infections
are caused by viruses, which are not affected by antibiotics, according
to the Infectious Diseases Society of America (IDSA), which released the
new advisory on Wednesday.
IDSA noted that the inappropriate overuse of antibiotics is encouraging
the development of tough-to-treat, drug-resistant bacteria or "superbugs."
An inability to determine which germ is behind a particular case of sinusitis
often leads to inappropriate prescribing, one expert said.
"There is no simple test that will easily and quickly determine whether
a sinus infection is viral or bacterial, so many physicians prescribe
antibiotics 'just in case,'" Dr. Anthony Chow, chair of the
guidelines panel and professor emeritus of infectious diseases at the
University of British Columbia, Vancouver, said in an IDSA news release.
"However, if the infection turns out to be viral -- as most are --
the antibiotics won't help and in fact can cause harm by increasing
antibiotic resistance, exposing patients to drug side effects unnecessarily
and adding cost," Chow noted.
Most sinus infections -- which can cause uncomfortable pressure on either
side of the nose and last for weeks -- develop during or after a cold
or other respiratory infection. But other factors, such as allergens and
environmental irritants, may play a role.
Experts agreed with the new guidelines.
The recommendations "recognize two common problems with previous guidelines:
bacterial rhinosinusitis is overdiagnosed and antibiotic resistance among
common sinus pathogens has increased significantly," said Dr. Richard
Lebowitz, an otolaryngologist at NYU Langone Medical Center and associate
professor at the NYU School of Medicine, in New York City.
He believes the recommendations are an "improvement" on prior
guidelines, but there are also "potential pitfalls" if a diagnosis
isn't clear. "The gold standard [for diagnosis], and the only
way to avoid misdiagnosis and improper treatment, is with endoscopy-based
diagnosis and culture-directed antibiotic therapy," Lebowitz said.
Another expert noted that there is often "confusion" in distinguishing
viral from bacterial sinusitis, because symptoms are often similar. Still,
"most patients want some kind of treatment when they go to the doctor,"
said Dr. Linda Dahl, an ear, nose and throat specialist at Lenox Hill
Hospital in New York City. "The new guidelines establish updated
recommendations for treating these patients in the primary care setting," she said.
The IDSA guidelines also recommend treating the small fraction of sinus
infections caused by bacteria with amoxicillin-clavulanate, rather than
the current standard of care, amoxicillin. This recommendation was made
due to increases in antibiotic resistance as well as the widespread use
of pneumococcal vaccines, which have altered the pattern of bacteria that
cause sinus infections, Chow explained.
The guidelines also recommend shorter antibiotic treatment times (five
to seven days) for adults with bacterial sinus infections.
Patients with either bacterial or viral sinus infections should avoid decongestants
and antihistamines, IDSA added. They are not helpful and could make symptoms
worse, the IDSA team said. Nasal steroids may help people with sinus infections
who have a history of allergies. Nasal irrigation using a sterile solution
in the form of spray, drops or liquid may help relieve some symptoms,
according to the guidelines.
Dahl said she found the guidelines, "very useful and in line with
the way I practice with a few exceptions." On the issue of decongestants,
she said, "I advocate for decongestants in relieving symptoms and
preventing viral infections from turning into bacterial infections. The
sinuses are literally holes in our skull that produce mucus. If the lining
of the sinuses becomes inflamed the mucus cannot drain and can harbor
bacterial growth. By keeping the passages open (with decongestants and
nasal sprays) the sinuses can heal more quickly."
Other treatments might help some patients, Dahl added, including "manual
suctioning of the sinuses, topical antibiotics [in certain cases], and
anti-inflammatories such as fish oil that are quite helpful and speed
recovery and most importantly, rest and good sleeping habits."
SOURCES: Linda Dahl, M.D., ear, nose and throat specialist, Lenox Hill
Hospital, New York City; Richard A. Lebowitz, M.D., FACS, otolaryngologist,
NYU Langone Medical Center, and associate professor, NYU School of Medicine,
New York City; Infectious Diseases Society of America, news release, March 21, 2012