Sinus study: Antibiotics overprescribed
Antibiotics are commonly prescribed for the majority of patients with sinus infections even though most cases are caused by a virus rather than bacteria, according to an analysis of treatments.
The researchers say the findings are troubling because overuse of antibiotics is leading to more virulent and even drug-resistent bacteria. Their concerns echo those of doctors who've studied the effectiveness of antibiotics on ear infections.
"We don't want to be using up our antibiotics on these people," said Dr. Don Leopold, chair of the University of Nebraska Medical Center's Department of Otolaryngology who worked on the sinus study.
The study, which appears in the March issue of the Archives of Otolaryngology, looked at two national surveys of patient data from 1999 to 2002. They showed 14.28 million doctor visits were for diagnosed chronic rhinosinusitis and another 3.12 million for acute rhinosinusitis.
Chronic rhinosinusitis, often called a sinus infection, is the inflammation of the sinus passages that lasts 12 weeks or longer. The acute version lasts for about four weeks.
Leopold said there are no approved drugs to treat sinus infections and no recommended course of treatment.
Of the cases of acute infection cited in the study, roughly 83 percent were treated with antibiotics. For chronic cases, that figure was about 70 percent. Combined, that accounts for a fifth of adults who are prescribed antibiotics each year and one-tenth of children treated that way.
Yet, according to the study, few cases of infection were caused by bacteria.
Dr. David Spiro, a pediatrician and professor at Oregon Health and Science University, said the number of cases treated with antibiotics is "extremely high for a condition that, for the most part, self-resolves."
Spiro has studied the effects of antibiotics on ear infections and said this study offers further evidence that doctors are overusing antibiotics.
In May 2004, the American Academy of Pediatrics and the American Academy of Family Physicians released the first national guidelines on appropriate diagnosis and treatment for ear infections. Among other things, those recommend that pain medication be prescribed for most children and antibiotics used only if the conditions persist or don't improve.
For most sinus infections, Leopold suggests an alternate treatment of saline flushing, which can be bought over the counter and is much cheaper than prescription medicine.
"It's a very old remedy, but something I think we physicians have forgotten," he said.
Dr. Melissa Pynnonen of the University of Michigan Health System said saline and other treatments that address the symptoms of the infection are best, but patients are not always receptive to them.
When a patient comes to a doctor for treatment, he or she often expects an antibiotic because it may have been prescribed in the past or because it is thought to be the quickest way to feel better, Pynnonen said.
"A lot of it is driven by patients' expectations," she said.
But that's not always what's best for them.
"Antibiotics are not harmless. They have side effects themselves," said Spiro. "You can have a really severe allergic reaction."
In addition to physical side effects, he and Pynnonen also cited increasingly drug-resistent bacteria that adapt to prescribed antibiotics.
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