A new study released in JAMA claims that the use of the antibiotic amoxicillin for acute uncomplicated rhinosinusitis, commonly known as a sinus infection, is not effective in treating symptoms. This news comes after researchers used the amoxicillin on some patients, and a placebo on others – the results were not significantly different.

Acute Rhinosinusitis is very common, affects millions of people, and can result in more serious health problems. The article states:

“Considering the public health threat posed by increasing antibiotic resistance, strong evidence of symptom relief is needed to justify prescribing of antibiotics for this usually self-limiting disease. Placebo-controlled clinical trials to evaluate antibiotic treatment have had conflicting results, likely due to differences in diagnostic criteria and outcome assessment.”

The article also states that antibiotic treatment should be saved for patients with moderately severe or severe symptoms, and 1 out every 5 antibiotic prescriptions in the U.S are sinusitis antibiotics.

Researchers from the Washington University School of Medicine, St Louis, conducted the study – they were led by Jane M. Garbutt, M.B.,Ch.B. The study analyzed 166 adults – 36% male, who were given a 10-day trial test of 3 doses per day of either amoxicilin (1,500mg/d; n = 85) or placebo (n = 81).

The volunteers reported mild symptoms, such as, postnasal discharge, cough, runny nose, and facial pain and pressure. All of the patients were given a 5-7 day treatment for the pain, nasal congestion, fever, and cough- to use whenever they felt it was necessary. Of the entire group, 92% used 1 or more of the treatments. (90 percent in the control group, 94% in the amoxicillin group)

Using the Sinonasal Outcome Test-16, researchers determined that after 3 to 4 days of disease-specific quality of life improved after medication. The second conclusion the researchers made was the volunteer’s altered sinus symptoms and the way they were able to function. The authors also looked at whether the symptoms returned, and how the patients felt about the treatment. These conclusions were analyzed using an interview over the phone at days 3,7,10, and 28.

Both groups, the amoxicillin group and the control group, produced scores that were relatively the same. The control group score on day 3 was 0.54, while the amoxicillin group was .59. On day 10, the difference in scores was a mere 0.01. However, on day 7 the amoxicillin group gave a score much higher, producing a difference of 19.

The authors state:

“There were no statistically significant differences in reported symptom improvement at day 3 (37 percent for amoxicillin group vs. 34 percent for control group) or at day 10 (78 percent for amoxicillin group vs. 80 percent for control group). At day 7, more participants treated with amoxicillin reported symptom improvement (74 percent for amoxicillin group vs. 56 percent for control group).”

The researchers also explained that the difference in both groups ,in terms of being able to go about their daily routines as usual, showed very little difference.

They conclude:

“There is now a considerable body of evidence from clinical trials conducted in the primary care setting that antibiotics provide little if any benefit for patients with clinically diagnosed acute rhino sinusitis. Yet, antibiotic treatment for upper respiratory tract infections is other both expected by patients and prescribed by physicians.

The National Institute for Health and Clinical Excellence guidelines in the United Kingdom, and more recent guidelines in the United States, suggest watchful waiting as an alternative approach to the management of patients for whom reassessment is possible ; this approach delays and may preclude antibiotic treatment while providing symptomatic treatments and an explanation of the natural history of the disease.”

Written By Christine Kearney