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Antibiotics, steroids no help for sinus infections. |
Amoxicillin and prednisone for sinus infection. Antibiotics, steroids no help for sinus infections
In the British study, people suffering from facial pain and a runny nose with greenish or yellowish mucous generally improved within about two weeks — whether they took the standard antibiotic amoxicillin, steroid nose spray or fake medicine. Antibiotics, particularly the penicillin-like drug amoxicillin, are among the most commonly prescribed medicines for sinus infections.
Steroid sprays sometimes are used, but the study found they also were no better than dummy drugs, although they appeared to provide some relief for patients with only minor symptoms. Ian Williamson of the University of Southampton in England. Inhaling steam and squirting salt water into the nose to flush out thick mucous are among other methods that sometimes provide relief, he said. Researchers randomly assigned adults to receive one of four treatments: milligrams of amoxicillin three times daily for seven days and units of steroid spray for 10 days, only amoxicillin, only steroid spray, or fake medicine.
Sinus infections are diagnosed in about 31 million Americans each year and are among the most common reasons for doctor visits. In the United Kingdom, primary care doctors see 50 or more cases a year, the study authors said. The infections affect air spaces called sinuses around the nose and in the lower forehead.
Inflammation and excess mucous can cause nose congestion, headaches and eye and face pain. Causes include bacteria, viruses, fungal infections and allergies.
The U. Marvin Fried, otolaryngology chairman at Montefiore Medical Center in New York, questioned whether all the patients in the study had true sinus infections. Still, Fried said the conclusions are in line with September guidelines from a group of head and neck doctors, whose treatment options included observation without antibiotics for mild sinus infections. IE 11 is not supported. For an optimal experience visit our site on another browser.
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❿Antibiotics and Steroids Ineffective in Sinus Infection | MedPage Today - Difference Between Steroids and Antibiotics
Amoxicillin and prednisone for sinus infection
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Median total symptom severity TSS scores for the two drugs together, each drug alone, and placebo were similar on every day of the study and reached zero on the ninth day for every treatment, reported Ian G. Williamson, M. However, a subgroup analysis indicated that budesonide had a significant benefit on certain symptoms when they were initially mild. In an accompanying editorial, Morten Lindbaek, M. Williamson and his colleagues said theirs was the largest randomized, placebo-controlled study of amoxicillin in acute sinus infection ever conducted without pharmaceutical company funding, and the only "adequately powered" study of budesonide in these patients.
The double-blind study involved patients seen in family practice clinics over a four-year period for uncomplicated acute sinusitis. They were assigned to four treatment groups: mg of oral amoxicillin three times a day for seven days plus a nasal placebo; micrograms of budesonide nasal spray once daily for 10 days plus an oral placebo; both active drugs; and both placebos.
Patients assessed their own symptoms on a seven-point severity scale, in categories including blockage and discharge for each nostril, four types of pain, unpleasant taste or smell, feelings of illness, and activity restriction. Patients tracked symptoms in a diary, which was to be turned in after two weeks or when they scored all symptoms as zero.
Diaries were not collected from 31 patients and two patients dropped out of the study because of ongoing symptoms, leaving patients in the primary analysis. Amoxicillin, either by itself or combined with budesonide, showed no significant effects on severity or duration of symptoms relative to placebo.
Anticipating criticism that the study involved a single antibiotic, Dr. Williamson's group cited studies showing similar effects in sinusitis for multiple antibiotic classes. Budesonide did have a detectable benefit in two symptom categories, "unwell" feelings and activity restriction, in patients who graded these symptoms as mild at presentation.
The amount of improvement declined with increasing initial symptom severity, and the drug was a clear detriment to patients with more severe initial symptoms. Williamson and his group calculated that budesonide's benefit relative to placebo at day 10 decreased by 0. Under this linear model, patients with initial scores of 1 for these symptoms had a benefit of 0. Those with baseline scores of 5 on these symptoms worsened by 0. Commenting on the clinical implications of their study, the researchers said that "topical steroids because of their local method of delivery to the mucosa are more likely to be of benefit at an early stage" of sinusitis.
However, he said, the small minority of sinusitis patients who have fever, malaise, and poor overall condition "still are in need of antibiotics. He said the evidence was equivocal for the use of nasal steroids in acute sinusitis. One large study found a statistically significant benefit, he said, but the clinical difference from placebo "was modest at best. Lindbaek said there may be patient subgroups, like the one identified in the Southampton study, that would show more benefit from either antibiotics or nasal steroids.
These might be identifiable in a large meta-analysis of individual patient data from multiple trials, he said. Source Reference: Williamson I, et al "Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial" JAMA ; Source Reference: Lindbaek M, "Acute sinusitis -- to treat or not to treat?
Share on Facebook. Opens in a new tab or window. Share on Twitter. Share on LinkedIn. Action Points Explain that the study found that oral antibiotics and nasal steroids, either alone or in combination, are not effective in acute sinus infections.
Explain that some patients with less severe initial symptoms benefited from the nasal steroid. The study was funded by the U. Department of Health. One co-author reported a financial relationship with Abbott Pharmaceuticals.
Just in time for runny nose season, new research suggests routine sinus infections aren't really helped by antibiotics and other medicine. The efficacy and tolerance of amoxicillin-clavulanate (ACA), with and without associated short steroid therapy, was evaluated in acute sinusitis of adults. Patients report feeling better and improving more rapidly. The combined use of corticosteroids and antibiotics is common in the treatment of sinusitis. Dear Dr. Roach: In late spring of , I had a sinus infection and was prescribed an antibiotic and prednisone. I was told that the steroid. Just in time for runny nose season, new research suggests routine sinus infections aren't really helped by antibiotics and other medicine. Williamson and his group calculated that budesonide's benefit relative to placebo at day 10 decreased by 0. However, a subgroup analysis indicated that budesonide had a significant benefit on certain symptoms when they were initially mild.Dear Dr. Roach: In late spring of , I had a sinus infection and was prescribed an antibiotic and prednisone. I was told that the steroid would increase the effectiveness of the antibiotic. After reading the patient insert for prednisone, I elected to take only the antibiotic, with excellent results.
Since that time, three of my friends also were prescribed antibiotics by three different doctors for various conditions; all were also prescribed prednisone to take with it. Two of them did take the prednisone, resulting in really unpleasant side effects.
This week I went to another doctor, was diagnosed with acute nasopharyngitis and was told to take an antibiotic and prednisone. I was prescribed clindamycin and methylprednisolone. I again elected not to take the steroid. Can you tell me if this dual prescribing is a widespread medical trend or just a local one?
Dear E. These studies have shown a speedier recovery in those taking the combination of steroids and antibiotics than in those who take antibiotics alone, and I suspect that is why your doctors, and those of your friends, have been prescribing them. However, there is a downside to steroids, as you note. In the long term, the list of possible side effects is very long, so the benefit must always be weighed against the possible harm. This is particularly the case in people at high risk for side effects, such as diabetics in whom sugar levels routinely go up when taking steroids or those with high blood pressure which often is exacerbated by steroid use.
Personally, I prefer to use nasal steroids in combination with antibiotics. They have many of the benefits of oral steroids with few of the side effects. Roach: I have read that atrial fibrillation gives you a greater chance of getting dementia. Do you agree? Dear K. What is clear is that people who are not treated well for atrial fibrillation specifically, those people whose anticoagulation dosage is frequently too much or too little have a greater risk for dementia than those whose atrial fibrillation is well-controlled.
This is yet another reason that both patients and doctors should take particular care with anticoagulation. View Comments. Email questions to ToYourGoodHealth med.
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