A new report indicates that antibiotics are being prescribed unnecessarily to treat sinus infections, a practice which contributes to the growing problem of bacterial resistance. The report appears in the March issue of Archives of Otolaryngology Head and Neck Surgery.

There is no easy solution, since medications which could be used as alternatives to antibiotics pose other problems.

"We as physicians don't have very good medications for chronic rhinosinusitis," said Dr. Donald A. Leopold, chairman of the department of otolaryngology at the University of Nebraska Medical Center. Leopold led the research team. "The only other drugs in contention are topical steroids, and they are not great. As a group I suggest we are frustrated at not having good drugs. It would be great if we had better medications for this chronic inflammation."

For the report, researchers examined the results of 2 nationwide studies. They found that between 1999 and 2002, patients made over 17 million visits to health-care providers in search of treatment for sinus infections. In approximately 83 percent of acute rhinosinusitis cases, patients received at least one antibiotic. 70 percent of patients who presented with chronic sinusitis also received at least one antibiotic.

Antibiotics help fight bacterial sinusitis, but they are not meant to treat sinusitis caused by viruses or allergies. However, patients often pressure doctors for relief of their pain and discomfort, demanding an antibiotic prescription. Direct-to-consumer marketing of antibiotics by pharmaceutical companies complicates the issue.

"Many patients call up and ask for specific antibiotics," Leopold said. "The patients know these names. They have been marketed to them, so they know the  drugs are available. And antibiotics do give some relief."

According to Dr. Neil L. Kao, vice chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology, doctors can figure out the cause of sinusitis through various methods. They can take a mucus sample from the nose through endoscopy or by using a swab from the nasal lining. They can also take an X-ray.

However, "The problem with all of these is that they are expensive and time-consuming," said Kao.

The Centers for  Disease Control and Prevention (CDC) recommends that doctors use "strict criteria for diagnosis" of sinusitis: runny nose or persistent cough lasting more than 10 to 14 days without improvement; or  symptoms of acute sinus infection, including fever with nasal discharge, facial pain or tenderness, and swelling around the eyes. By urging physicians to use these criteria, the CDC hopes to reduce the number of unnecessary antibiotic prescriptions.

Drug free advice

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