by Playfuls Staff |
20th March 2007
Though extremely few sinus infections are caused by bacteria, antibiotics continue to be widely overprescribed as treatment.
[more]
Studies suggest that only about 3 percent to 5 percent of acute sinus infections are bacterial in nature, in that they respond to antibiotic treatment.
Researchers used data derived from two national studies assessing prescribing practices for sinus infections in physicians' offices and hospital ERs. They concluded that antibiotics were prescribed for four out of five patients with acute sinusitis and two-thirds of patients with chronic sinusitis.
The two surveys were conducted between 1999 and 2002, and they included approximately 14.2 million health care visits for chronic sinus infections and 3.1 million
visits for acute sinus issues during the time period.
The most widely prescribed treatments for both acute and chronic sinus infections were antibiotics, followed by antihistamines, nasal decongestants, inhaled corticosteroids, expectorants and other antimucus agents.
Among the prescribed antibiotics, penicillins were the most commonly recommended, followed by cephalosporins (also antibiotics). Antibiotics were prescribed 70 percent of the time during health care visits for chronic sinus infections and 83 percent of the time for acute sinus infections.
“The vast use of [antibiotics] makes the statement that they seem to be
effective in reducing symptoms or preventing relapse, or they would have been abandoned,” Leopold and colleagues write. “Another important possibility is that many patients have self-limited disease that will resolve regardless of treatment, and their physicians could be prescribing what they think will work.”
They concluded that, "Prescription antibiotic drugs are being used far more than bacterial causes studies would indicate," as the use of over-the-counter medicines or home remedies was not recorded.
The researchers also assessed that, “Nasal and inhaled corticosteroids are prescribed more frequently to treat acute rhinosinusitis than published studies imply is necessary.” However, they estimated that where antihistamines were prescribed, this was roughly in proportion with estimated prevalence of allergic sinusitis.
Leopold said there are no approved drugs to treat sinus infections and no recommended course of treatment. An efficient and cheap treatment for nonbacterial acute sinus infections is flushing the nose frequently with a saline nasal spray.
Rhinosinusitis, an inflammation of the sinus cavities (adjacent to the nasal passages) and commonly referred to as a sinus infection, is a common and expensive medical condition in the United States, according to background information in the article.
In 2002, rhinosinusitis accounted for 21 percent of all antibiotic prescriptions for adults and 9 percent of those for children. The infection is considered acute when symptoms last up to four weeks, and chronic when symptoms persist for 12 weeks or longer.
Acute rhinosinusitis is usually thought to be caused by infectious agents, while allergies, facial anatomy and hormonal changes may contribute to chronic cases.
The study appears in the March issue of the Archives of Otolaryngology.
