Sinusitis is usually not helped by antibiotics
Summary: Although antibiotics are commonly used to treat sinusitis though there has been no reliable evidence to support this practice. A recent study shows that in most cases they do not really benefit.A study just published in The Journal of the American Medical Association finally seeks to answer the question "do antibiotics really help treat acute sinusitis"? The authors state:
"Evidence to support antibiotic treatment for acute rhinosinusitis is limited, yet antibiotics are commonly used."
They randomized 166 adults with acute sinusitis to receive either a 10 day course of amoxicillin or placebo in order to...
"...determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute rhinosinusitis."
All patients received a supply of symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed. As a metric they used the Sinonasal Outcome Test, changes in sinus symptoms and overall functional state, relapse, satisfaction and adverse effects of treatment. How did the outcomes compare?
"The mean change in Sinonasal Outcome Test-16 scores was not significantly different between groups on day 3 (decrease of 0.59 in the amoxicillin group and 0.54 in the control group; mean difference between groups of 0.03) and on day 10 (mean difference between groups of 0.01), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19). There was no statistically significant difference in reported symptom improvement at day 3 (37% for amoxicillin group vs 34% for control group) or at day 10 (78% vs 80%, respectively), whereas at day 7 more participants treated with amoxicillin reported symptom improvement (74% vs 56%, respectively). No between-group differences were found for any other secondary outcomes. No serious adverse events occurred."
The authors state in their conclusion:
"Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment...There is now a considerable body of evidence from clinical trials conducted in the primary care setting that antibiotics provide little if any benefit for patients with clinically diagnosed acute rhinosinusitis."
Guidelines recently released here and in the U.K. suggest 'watchful waiting'. The CDC currently recommends treating only severe cases with antibiotics. Jay Piccirillo, MD, of Washington University in St. Louis, one of the study's authors, stated in The JAMA Report:
"It provides further evidence for what we've really suspected for a long time -- that in the management of patients with acute sinusitis, antibiotics do not convey any additional benefit."
While antibiotics don't help most cases of sinusitis (which are viral), there are of course interventions that do support the body's intrinsic resources.