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Amoxicillin Does Not Appear Effective for Acute Maxillary Sinusitis

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Acute sinusitis is a common illness that results from an infection in the sinuses which are hollow spaces in the facial bones. The infection may be caused by bacteria or a virus. Symptoms include nasal congestion, fever, and often pain. Most acute sinus infections resolve on their own. However, uncomfortable patients go to their primary care doctors hoping for quick relief from antibiotics or a steroid nasal spray. Using antibiotics when not necessary has led to increasing rates of bacterial resistance to antibiotics. The resistance make antibiotics less effective and bacteria more dangerous for everyone. For this reason, researchers set out to discover if antibiotics are necessary for treatment in acute maxillary sinusitis.

Many studies have already found no benefit from antibiotics for acute sinusitis. A recent study published in JAMA supports the findings in a randomized control study of amoxicillin and budesonide nasal spray. There was no improvement in symptoms in patients who took the antibiotic medications compared to placebo (fake pill).

About the Study

The researchers enrolled 240 adults over the age of 16 years acute sinusitis. Amoxicillin was prescribed as 500 mg 3 times daily for seven days and budesonide (Rhinocort Aqua) prescribed as 200 µg in each nostril once daily for 10 days. Patients were randomly divided into four groups:

  • Group A received amoxicillin and budesonide
  • Group B received placebo and budesonide
  • Group C received amoxicillin and placebo nasal spray
  • Group D received placebo and placebo nasal spray.

Patients had reported 2 or more of the following symptoms: purulent rhinorrhea (runny nose) with one nostril worse than the other, local pain with one side worse than the other, runny nose on both sides, or pus in the nose cavity.

There were no major differences in the rate of improvement for patients. About 30% of patients in all four groups had symptoms for 10 days or longer. Even the use of both antibiotics did not make a noticeable change.

There was no difference between groups in the amount of time it took for the symptoms to go away completely. About 40% of participants in all groups were cured within one week. Pain had resolved within the first 7 days for most patients in the study. After analyzing special groups of patients in the study with similar symptoms, it seems that budesonide (nasal spray) helped patients with very mild symptoms but worsened the illness for those with severe symptoms.

How Does This Affect You?

This study reminds us that antibiotics are not always the answer. Most sinus infections are caused by viruses and improve on their own in 1-2 weeks. There are many treatments that can help treat symptoms and decrease your discomfort like nasal decongestants, pain relievers, humidifiers, and saline nasal sprays. Next time you have a sinus infection, you may want to wait a few days before going to your doctor for a prescription. A more conservative approach to caring for your next sinus infection may be just what the doctor ordered.

  • American Academy of Family Physicians

    http://www.aafp.org

  • US Department of Health and Human Services

    http://www.ahrq.gov/clinic/epcsums/rhinoupsum.htm

  • Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA . 2007;298:2487-2496.