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Medicine

Antibiotics Are Useless In Treating Most Sinus Infections 377

Posted by timothy
from the coulda-told-you-that dept.
An anonymous reader writes "While doctors routinely prescribe antibiotics to treat sinus infections, researchers on Tuesday revealed that amoxicillin, the most commonly prescribed medication for nasal cavity inflammation and sinuses, was just as effective as a dummy pill. Researchers from the Washington University School of Medicine in St. Louis, Missouri, found that there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."
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Antibiotics Are Useless In Treating Most Sinus Infections

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  • by fredrated (639554) on Thursday February 16, 2012 @11:33AM (#39060393) Journal

    "there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."

    • by compro01 (777531) on Thursday February 16, 2012 @11:36AM (#39060449)

      Each group started on their pills and they checked for effect 3 days later.

    • by rubycodez (864176) on Thursday February 16, 2012 @11:37AM (#39060473)
      amoxicillin, because there are no other antibiotics on planet earth.

      yeah focus on symptoms, because progression of infection is irrelevant. three days, because all antibiotics cure by monday morning if course started friday morning
      • by rwven (663186) on Thursday February 16, 2012 @11:53AM (#39060793)

        My thought exactly. Clindamycin and Biaxin are especially good at treating sinus infections. Why they used a drug like amoxicillin is beyond me...

        • by X0563511 (793323)

          Allergies, perhaps?

          Though in my case it's the *cillin family I'm allergic to, so I need the alternatives.

      • by sjames (1099)

        No, amoxicillin because that is by far the most common prescription for sinus infections. It makes sense to see if that's actually helping, doesn't it? Now that we know it isn't, we know we need to consider either no prescription or a different one. We can then do studies to see how that works out.

        • The interesting and annoying bit here is that the title of the thread is "Antibiotics are Useless In Treating Most Sinus Infections" - and for once, this isn't just bad editing on Slashdot's part. It's how the article is being hyped in the media.

          The actual take home lesson is that "Amoxicillin doesn't help significantly in most cases of uncomplicated acute sinusitis". Rather a different take home lesson. There were good reasons to use amoxicillin but Jesus Christ on a Popsicle, can't the media get anythi

          • Re: (Score:3, Funny)

            by skydyr (1404883)

            Don't you know that all antibiotics are the same, work on the same infections in the same manner, and are only renamed for marketing purposes and in case some idiot thinks he has an allergy to one?

    • "there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."


      there was no significant difference
      in symptoms
      between patients taking amoxicillin to those who took the placebo
      three days
      after starting the pills were administered.

      Humans are bad at understanding nested stuff, luckily for me, I'm a programmer.

      • by CSMoran (1577071)

        Humans are bad at understanding nested stuff, luckily for me, I'm a programmer.

        You're definitely not a compiler -- you missed the syntax error at the end of the original sentence...

        • by X0563511 (793323)

          Hrm, it would be interesting if a compiler could detect simple stupid mistakes and bitch about them, and then proceed to build correctly. Though that would be done in preprocessing right?

          Yo dawg, i heard you like compiling, so I put a compiler in your compiler...

    • In most cases?

      Most likely, there was no measurable change between the two groups. I have had all sorts of antibiotics prescribed to me for various issues, amoxicillin is only given in the least annoying conditions by my doctor. I have done the zpacs (amoxicillin), cefalexin, and in one case I had cipro (which I will not wish on anyone, it worked but side effects were not fun and it was not for a sinus infection)

      I have pretty much gotten away from drugs for a sinus infection unless it doesn't seem to sort it

  • by svendsen (1029716) on Thursday February 16, 2012 @11:34AM (#39060415)
    Whiskey!
  • Biofilms (Score:5, Insightful)

    by tmosley (996283) on Thursday February 16, 2012 @11:36AM (#39060447)
    You can't effectively treat biofilms with antibiotics. And that is exactly what this type of infection is--a biofilm.

    A better approach is the use of biofilm "release" enzymes that signal the cells within the biofilm to stop producing EPS and detach from whatever surface they are clinging to. Use of such enzymes alongside antibiotics in a medical setting is likely to work even better.
    • I'm by no means an expert in the field, but wouldn't that increase the risk of sepsis for some types of infections? I mean, the last thing you want is for the bacteria to start spreading throughout the circulatory system, and telling them to split up and release seems like it might do just that.

      • Re:Biofilms (Score:5, Informative)

        by tmosley (996283) on Thursday February 16, 2012 @12:15PM (#39061189)
        That is why you combine the treatment with antibiotics. Planktonic bacteria are highly susceptible to all manner of natural and artificial defenses. If the area has the release enzyme in place, then they won't settle on a surface and start growing. The body can deal with individual bacteria in the bloodstream pretty easily. It's likely clots of biofilm that cause problems.
    • by ackthpt (218170)

      You can't effectively treat biofilms with antibiotics. And that is exactly what this type of infection is--a biofilm.

      A better approach is the use of biofilm "release" enzymes that signal the cells within the biofilm to stop producing EPS and detach from whatever surface they are clinging to. Use of such enzymes alongside antibiotics in a medical setting is likely to work even better.

      I just eat spicy food (liberal use of capsicums.) My body reaction is to produce more sinus mucus. Seems to work, not enirely certain how, though perhaps someone more informed on what the increase does .. though it is worth noting most of these infections coincide with winter and thus drier air. Keeping sinus from drying or keeping the mucus in productions appears to limit spread and duration of infections (though could this be how the body is meant to work?)

      • by tmosley (996283)
        Sounds dumb, but it's actually highly effective. Unless the tissue itself is compromised (it always will be to some extent), the mucus production will float the infected mass away and confine it. It is also helpful to use a neti pot (clean water please), as that will wash away anything that is physically jammed in your upper sinuses. That is personal experience, not a course advised by systematic studies (my lab does only in vitro and animal work).
      • by Pharmboy (216950)

        Take two dozen spicy wings, drink lots of fluids, and call me in the morning.

        Yes, it does work well from my experiences. I eat a lot of spicy food anyway, but ramping it up with lots of water does seem to open up the head. Capsicums are irritants (tasty irritants) that make your sinuses want to float them out. As long as you drink plenty of water with them, your body will do the rest. Not sure about a major sinus infection, but it surely works great on the typically stuffy head syndrome that I get often

  • We've known for years that Doctors have over prescribed Antibiotics for many ailments, simply because people just don't want to feel miserable when they get sick. And since most people can't afford time off of work they don't take it or won't take it for fear of the backlash from a company, people still go to work and infect others and the cycle continues. The cheap solution is to take pills instead to resolve the immediate illness.

    • by khb (266593) on Thursday February 16, 2012 @11:42AM (#39060569)

      Unfortunately some people need them. My son hearing loss is ascribed to under treatment of sinus infections

      Few doctors use an endoscope to examine and sample the nasal passages. So they prescribe blind. That is what's ineffective. When they can see and sample the pus diagnosis and choice of an antibiotic suitable for the specific pathogen is reliable.

      Pity the paper didn't point out the effective course of treatment, focusing solely on the known (but common) ineffective approach.

      • by sjames (1099)

        To be fair, step one is to show that the current approach isn't working. That done, it becomes worthwhile to examine other approaches to see what does work.

    • by tmosley (996283)
      For such problems, phage is likely a better treatment. An old friend of mine is working on introducing therapeutic phage to America. His results are quite stunning.
    • by sjames (1099)

      I suspect it won't get any better until we make sick pay (or telework days) mandatory. Until then, there are simply too many people who literally can't afford to be sick and are forced to show up fro work even if they carry the plague. Ultimately, it probably costs the economy a lot more than it saves. It also maximizes our chances for a pandemic.

      To be fair, this shouldn't be yet another unfunded mandate.

  • by stillnotelf (1476907) on Thursday February 16, 2012 @11:38AM (#39060495)
    http://jama.ama-assn.org/content/307/7/685.short [ama-assn.org] I can't tell if it's paywalled or not - it appears to be. Pubmed hasn't indexed it yet (not that they offer free articles from JAMA anyway).
    • by stillnotelf (1476907) on Thursday February 16, 2012 @11:44AM (#39060615)
      Here are some interesting points from the paper:

      A) Someone's got a sense of humor: "The primary outcome was measured using the modified Sinonasal Outcome Test-16 (SNOT-16), a validated and responsive measure."

      B) They did no testing whatsoever to ensure the sinus infections _were_ bacterial - but they apparently usually are, and are usually diagnosed as such symptomatically instead of by culture (in other words, they followed normal practices in deciding who to give antibiotics to).

      C) They did no testing to see if resistant bacteria could be isolated from any patients.

      Putting B and C together...clearly the medical community is overprescribing antibiotics, but there may be some question of whether it's resistant bacterial infections or poor diagnosis of bacterial vs. viral infections.

  • Obvious... (Score:5, Insightful)

    by Covalent (1001277) on Thursday February 16, 2012 @11:39AM (#39060521)
    Most sinus infections are viral. Nothing to see here.
    • From the paper: "All study participants met the recommended clinical criteria for acute rhinosinusitis[1] and are representative of patients for whom antibiotics might be prescribed." [1] is Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande MA, American Academy of Family Physicians; American College of Physicians-American Society of Internal Mediciine; Centers for Disease Control; Infectious Diseases Society of America. Principles of appropriate antibiotic use fo
      • OP is correct, though. Troublesome to see a rather recent publication (2001) giving the wrong advice for such a "standard" disease.

      • Re:Obvious... (Score:4, Informative)

        by level_headed_midwest (888889) on Thursday February 16, 2012 @12:37PM (#39061593)

        You are both right. Most sinus infections are viral, and many patients with viral sinus infections demand that the doctor "do something," which generally means they want antibiotics. Many times they still demand antibiotics even though the doctor explains that antibiotics will not work for their *viral* infection. Thus anybody with sinusitis, be it viral or bacterial, is somebody who "might" be prescribed antibiotics.

    • by BoRegardless (721219) on Thursday February 16, 2012 @12:12PM (#39061133)

      It is entirely possible for a virus to give tissue damage that then results in a bacterial infection or visa versa!

      Hence, I can easily believe that a rhinovirus could easily prevent clearing up a sinus infection with bacteria.

      Biofilms, as mentioned by others, may also be an important variable.

      It is anything but simple "Yes or No."

  • Azithromycin (in the form of a Tri-Pak [drugs.com]) sure seems to make a dent in my sinus/bronchial infections.
  • Over-extapolating (Score:5, Insightful)

    by wonderboss (952111) on Thursday February 16, 2012 @11:42AM (#39060573)

    Big leap from "no significant difference in symptoms between patients taking amoxicillin to those who took the placebo"
    to "Antibiotics Are Useless In Treating Most Sinus Infections". How many bugs are resistant to amoxicillin at this point?
    How many of the patients had bacterial infections?

  • inaccurate summary (Score:4, Insightful)

    by cinnamon colbert (732724) on Thursday February 16, 2012 @11:44AM (#39060605) Journal
    abstract is here http://jama.ama-assn.org/content/307/7/685.abstract [ama-assn.org]
    story itself, paid for probably with tax dollars is paywalled
    The abstract says that yes, at 3 days, amoxicillin and placebo similar, but there was a diff at day 6
    Also, total number of patients studied is quite small - Typical Bull**** "MD" science - mds just don't know how to do science, and they constantly flood the literature with these worthless studies, so the net result is a negative, cause you have towaste brain power to not pay attention

    However, what is of more interest is the hard to read format of the abstract, which is a deliberate format imposed by the medical journals; the use of statistics in parenthesis, eg quote, mean difference between groups of 0.03 [95% CI, 0.12 to 0.19]) and on day 10 (mean difference between groups of 0.01 [95% CI, 0.13 to 0.15]), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19 [95% CI, 0.024 to 0.35]).
    makes the abstract almost impossible to read; this practice has been criticized, but the idiot mds of course don't listen.
    Not only that, with the number of people in the study, if you know naything of the history of medical studies, to give CIs is just BS, crazy statistics for no reason other then to tget a publication or satisfy the wierdness of hte editors; everything that is wrong with academic medicine is in this abstract
    sorry for rant
    • by tibit (1762298)

      I wish you weren't right, but right you are. 166 adults, haha. Anyway, I love the cut-off conclusion. What they say:

      Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment.

      What they meant to say: Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment. The symptoms were reduced at day 7 of treatment. Another important point: if the symptoms appear to be reduced at day 7, but not reduced at days 3 and 10, then you may wish to question the test you're using (SNOT-16 in their cas

  • Nope (Score:5, Insightful)

    by geekoid (135745) <dadinportland @ y a hoo.com> on Thursday February 16, 2012 @11:45AM (#39060627) Homepage Journal

    THE AC submission was alarmist and wrong.

    The research did not show the anitbiotics are useless.

    It showed the Amoxicillin had no significant statistical difference at day three. BUT statistically significant results on day 7, no difference on day 10.

    What this means is the people taking Amoxicillin got better sooner.

    The person who wrote the headline and summary should be ashamed of themselves.

  • This is no different than the common cold, 90% of which come from a virus instead of bacteria.
    • I read a few months back about anti-viral medicines in the works that could end up being a effective against wide-ranges of viruses as anti-biotics are against bacteria.

      Could be revolutionary if true. Until virus evolve to resist them at least.

  • by james_van (2241758) on Thursday February 16, 2012 @11:50AM (#39060713)
    i currently a) have a sinus infection, b) am taking amoxicillin to treat it, and c) am completely miserable. hey science, thanks for making my day even worse!
  • by Oswald McWeany (2428506) on Thursday February 16, 2012 @11:58AM (#39060857)

    Can someone tell me where I can buy a pack of placebos please?

    They seem to be really usefull in fighting off all sorts of diseases.

  • Are antibiotics ineffective on sinus infections because the infection is viral and not bacterial or could it be that the common bacteria responsible for such an infection has grown resistant to the antibiotic?
  • by Bhrian (531263) on Thursday February 16, 2012 @12:20PM (#39061309) Journal
    A Mayo clinic study found 70% of sinus infections are viral instead of bacterial, so antibiotics actually make the infection worse. In addition, the antibiotics harm the rest of your immune system, leaving your worse off than before. My ENT introduced me to anti-viral nasal sprays for sinus infections. More of the drug reaches the infection and your GI system is left unharmed. The catch is they must be compounded at a pharmacy, need to be refrigerated, and are only good for 30 days. Many insurance companies cover them, but a lot of doctors don't know that option exists and just prescribe antibiotics.
  • the antibyotics factories have a different view. Very different.

  • I noticed this study was only conducted on adults. I'd be curious if the results would be replicated in children as well. When my kids were younger, they had sinus infections at least twice a year and would get amoxicillin every time. If a sinus infection would clear up on its own about as fast, there wouldn't have been as much need for the constant doctor visits.

    The article says sinus infections account for 20% of all antibiotics prescribed for adults. I'd be surprised if that number wasn't over 50%

  • Anyone who has been to the doctor for a sinus infection has been told that they are rarely bacterial in origin, and are almost exclusively viral.

    They give antibiotics as a precaution and as a placebo, as patients feel better taking *something*, regardless whether it is effective.
  • Even if they can cure it, aren't antibiotics reserved for serious illnesses that can't be cured by other means? You can cure a cold dozens of other ways without breeding a new strain of resistent bacteria, what the hell is wrong with you Americans?

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