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Community Corner

The Symptoms Associated with Sinusitis

After years of antibiotic treatment, experts are questioning the necessity.

Sinusitis, an inflammation of normally air filled spaces within the skull, is a common condition in both children and adults.

When the normally sterile sinuses become inflamed, the drainage passages become clogged, bacteria proliferate, and symptoms ensue. Traditionally, antibiotic therapy is the treatment of choice for sinusitis. However, the Feb. 15 issue of the Journal of the American Medical Association adds to a growing body of evidence, which questions the necessity of this therapy in all patients.

Sinusitis is classically associated with a number of symptoms — fever, headache, facial tenderness, toothache, nasal discharge and congestion. The initiating event is often a viral upper respiratory tract infection or an allergy, which causes the blocked drainage pathway. The subsequent infection may be caused by either a virus or bacteria.  Whereas viral infections are not affected by antibiotics, it has been thought that the situation is different with bacteria, hence the traditional therapy with antibiotics.

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The study referred to above, reported by researchers from the Washington University School of Medicine, looked at 166 adults with facial or tooth tenderness and thick nasal discharge. All patients received acetaminophen for pain or fever, cough medicine and decongestant therapy. Half received the antibiotic amoxicillin and half received an identical placebo pill. Patients were contacted by phone three, seven, 10 and 28 days into treatment. Overall, the two patient groups had similar outcomes, with the conclusion being that amoxicillin had no effect on the underlying condition.

Given that up to 20 percent of antibiotic prescriptions in the United States are written for sinus and upper respiratory tract infections, this study has important implications. Perhaps, as has been suggested, patients get better irregardless of antibiotics, and not because of them.

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It is important to note that some physicians have raised concerns about the conclusions. Rarely, sinus infections can spread to the surrounding or deeper tissues, even leading to serious complications such as brain abscesses. However, there are certain populations more at risk of these serious complications, particularly patients with altered immune systems or prior sinus surgery.  Patients with diabetes, HIV infection, cystic fibrosis or active pregnancy should be approached differently, as should patients with other medical conditions such as heart, lung, kidney and liver disease.

The important lesson here is that in sinusitis, as with other infections, antibiotics are not a magic cure all.  They have side effects, and overuse in the community will lead to bacterial resistance and danger to all of us by virtue of the emergence of “super bugs” (such as MRSA). Having a trusted primary care physician to evaluate your symptoms, put your concerns in perspective with your overall health profile, and to discuss the best treatment plan for you is always better than saying “infection equals antibiotic therapy”.

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