Sinus Sufferers May Be Getting the Wrong Treatment
Every year sinus infections afflict about 37 million Americans, sending many of them to the doctor for relief. The problem, according to a new study, is that the prescribed relief may not be appropriate; despite the fact that most acute infections are caused by a virus, patients are overwhelmingly getting bacteria-killing antibiotics.
Researchers at the University of Nebraska Medical Center in Omaha looked at data from two large government studies of visits to doctors' offices and hospital outpatient departments and emergency rooms. They found that between 1999 and 2002, there were more than 14.2 million annual visits because of chronic sinus infectionsthose present for more than 12 weeksand more than 3.1 million annual visits because of acute infections, defined as lasting less than four weeks.
Of all the patients seeking treatment for acute infections, almost 83 percent came away with at least one prescription for an antibiotic. Because most of these short-term infections are caused by a virus, the most effective treatment is to wait it out, rinse twice daily with salt water, and perhaps take a decongestant to treat the symptoms. Chronic sinus infections aren't as well understood, but it's believed that inflammation plays a key part; even so, almost 70 percent of patients seeking treatment for long-term sinus problems were prescribed an antibiotic.
Those numbers suggest large-scale overprescription of antibiotics, the authors say in the study, which appears in the current Archives of Otolaryngology-Head & Neck Surgery. The worry is that when antibiotics are used unnecessarily, they knock out only some bacteria; others, resistant to the drugs, can breed and proliferate, making the drug ineffective when used the next time.
Given that doctors presumably know that a virus, not a bacterial infection, is the likely cause, why prescribe antibiotics? "It's a complicated question," says Donald Leopold, chair of otolaryngology-head and neck surgery at UNMC and an author of the study. "Patients demand antibiotics because they've seen an ad, and for doctors, it's quicker to write a prescription than to explain how to rinse with salt water." (It's possible that the prescription trends have improved since 2002, since there's been a concerted effort to make both doctors and patients aware of the dangers of using antibiotics unnecessarily, Leopold says.)
Rinsing is the easy remedy he suggests patients with an acute infection use as their initial defense; if they rinse for a few days before heading for the doctor, about half will be able to cancel their appointment.