Antibiotics Don't Help Much in Most Sinus Infections

For mild sinusitis, forgoing drug treatment makes sense, experts conclude.

Man with sinus infection

People with mild sinus infections may be best off toughing it out rather than turning to an antibiotic, which research increasingly suggests isn't likely to speed their recovery. Two studies in recent weeks, including one published today, have reached that basic conclusion.

What the new research shows is that "observing patients is an option if the patient has mild illness," says Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y. He emphasizes that the findings don't apply to patients with chronic sinusitis or to those who have more serious illness—indicated by, for instance, a fever higher than 101 degrees or severe pain—because those patients have been excluded from most studies in which some people don't get antibiotics.

The latest research, by the Cochrane Collaboration, reviewed dozens of such studies. (Last month, a separate study appeared in The Lancet.) The Cochrane group, which produces reviews of healthcare interventions, found that antibiotics may have a "small treatment effect" in patients with mild sinusitis and symptoms for more than seven days. But, the report notes, eight out of 10 patients improve without antibiotics within two weeks, so "clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects." Any benefit gained by prescribing medicine, the report continues, may be "overridden by the negative effects of antibiotics, both on the patient and on the population in general."

Doctors who routinely treat sinusitis aren't surprised by the group's findings. "I think that most illnesses in general tend to get better on their own," says Stanley Chia, a staff otolaryngologist at Washington Hospital Center in Washington, D.C. Forty million Americans get sinusitis every year, according to the Mayo Clinic; triggers include allergies, bacteria, and viruses like those that cause the common cold. Antibiotics are effective only in treating bacterial illnesses.

Acute sinus infections may be routinely overtreated. The March Lancet study concluded that antibiotics aren't needed even if a patient reports symptoms for longer than seven to 10 days. And a study published in the Journal of the American Medical Association in December found that neither an antibiotic nor a nasal steroid was effective in treating acute sinusitis. The American Academy of Otolaryngology-Head and Neck Surgery—a group of ear, nose, and throat specialists—issued adult sinusitis treatment guidelines in September that suggest clinicians watch patients with mild bacterial sinus infections for up to seven days before prescribing antibiotics, according to Rosenfeld, who chaired the committee that produced the guidelines.

U.S. News has tips on self-managing sinus infections without resorting to antibiotics.