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Antibiotics 'no better than placebo' for sinus infections

Washington, Wed, 15 Feb 2012 ANI

Washington, Feb 15 (ANI): Antibiotics are no better than an inactive placebo in improving symptoms for sinusitis, a new study has suggested.


Investigators at Washington University School of Medicine in St. Louis say, in fact, most people get better on their own without using antibiotics.


"Patients don't get better faster or have fewer symptoms when they get antibiotics," said Jay F. Piccirillo, MD, professor of otolaryngology and the study's senior author.


"Our results show that antibiotics aren't necessary for a basic sinus infection - most people get better on their own," he stated.


Jane M. Garbutt, MD, research associate professor of medicine and the paper's first author said, "We feel antibiotics are overused in the primary-care setting."


"There is a movement afoot, led by the Centers for Disease Control and Prevention, to try to improve the judicious use of antibiotics. We hope this study provides scientific evidence that doctors can use with patients to explain that an antibiotic is not likely to help an acute sinus infection," Garbutt noted.


In practice, instead of giving antibiotics, such as the amoxicillin used in this study, the researchers suggest treating symptoms, such as pain, cough and congestion, along with watchful waiting to see whether further treatment is necessary.


The study included 166 adults whose symptoms fit the criteria for acute sinus infection recommended by an expert panel convened by the Centers for Disease Control and Prevention. To participate, patients' symptoms had to be classified as moderate, severe or very severe.


The patients were recruited at their primary-care physicians' offices in St. Louis and were randomly assigned to receive a 10-day course of either amoxicillin or placebo. Whether on amoxicillin or not, all patients also got medications for relieving pain, fever, congestion and cough.


The researchers assessed the patients' symptoms at the start of the treatment and then three, seven, 10 and 28 days afterward.


At each time point, patients answered a questionnaire assessing quality-of-life measurements related to the disease called the Sinonasal Outcome Test-16 (SNOT-16). They also compared relapse and recurrence of symptoms and days missed from work.


At day three, they found no difference between the antibiotic and placebo groups in any of these measures. At day seven, a small improvement was seen in the antibiotic group's questionnaire scores. However, Garbutt says this small change was unlikely to represent a noticeable relief from symptoms.


"On a scale of 1 to 3, we calculated that a clinically significant difference would be a change of 0.5 in the SNOT-16 score. The difference at day seven was 0.19. Even though it was a statistically significant change, it's likely not a change that a patient would notice," Garbutt stated.


Furthermore, this modest statistical improvement disappeared by day ten, when about 80 percent of patients in both groups reported their symptoms were very much improved or cured.


They also found no difference between the antibiotic and placebo groups in the amount of medications patients chose to use to alleviate pain, fever, congestion and cough.


The study appeared in the current issue of the Journal of the American Medical Association. (ANI)


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