Antibiotics may not aid sinus infections
Wed, 05 Dec 2007 04:14:17 GMT
By LINDSEY TANNER, AP Medical Writer
CHICAGO - Just in time for runny nose season, new research suggests routine sinus infections aren't really helped by antibiotics and other medicine that's often prescribed.
In the British study, people suffering from facial pain and a runny nose with greenish or yellowish mucous generally improved within about two weeks — whether they took the standard antibiotic amoxicillin, steroid nose spray or fake medicine.
The results, based on patients' reporting whether their symptoms had improved, echo previous findings in children.
Antibiotics, particularly the penicillin-like drug amoxicillin, are among the most commonly prescribed medicines for sinus infections.
Steroid sprays sometimes are used, but the study found they also were no better than dummy drugs, although they appeared to provide some relief for patients with only minor symptoms.
The study should lead to a "reconsideration of antibiotic use for acute sinusitis. The current view that antibiotics are effective can now be challenged, particularly for the routine cases which physicians treat," said lead author Dr. Ian Williamson of the University of Southampton in England.
"Physicians can focus on effective remedies that improve symptom control," which include ibuprofen and other over-the-counter painkillers, Williamson said.
Inhaling steam and squirting salt water into the nose to flush out thick mucous are among other methods that sometimes provide relief, he said.
The study appears in Wednesday's Journal of the American Medical Association.
Researchers randomly assigned 240 adults to receive one of four treatments: 500 milligrams of amoxicillin three times daily for seven days and 400 units of steroid spray for 10 days; only amoxicillin; only steroid spray; or fake medicine.
Patients on the drugs didn't get better quicker than those using the placebo.
Sinus infections are diagnosed in about 31 million Americans each year and are among the most common reasons for doctor visits. In the United Kingdom, primary care doctors see 50 or more cases a year, the study authors said.
The infections affect air spaces called sinuses around the nose and in the lower forehead. Inflammation and excess mucous can cause nose congestion, headaches and eye and face pain. Causes include bacteria, viruses, fungal infections and allergies.
Despite a long-held notion, recent studies have found that yellowish or greenish mucous doesn't always mean the infections are bacterial, said Dr. Vincenza Snow, a Philadelphia internist and director of clinical programs and quality of care at the American College of Physicians.
Moreover, while antibiotics are designed to treat bacteria, these drugs aren't always very effective at treating bacterial sinus infections because the medicine has a tough time reaching the sinuses, she said.
The U.S. physicians' group issued guidelines in 2001 advising against using antibiotics for most sinus infections in otherwise healthy people, blaming overuse for contributing to the growing problem of bacteria resistant to drugs.
The group is considering updating the guidelines to say recent evidence reaffirms the drugs "don't really change the course of the illness," Snow said.
Dr. Marvin Fried, otolaryngology chairman at Montefiore Medical Center in New York, questioned whether all the patients in the study had true sinus infections. While patients were recruited by family doctors, the results were based on patients' self-reported symptoms rather than medical exams, he noted.
Still, Fried said the conclusions are in line with September guidelines from a group of head and neck doctors, whose treatment options included observation without antibiotics for mild sinus infections.
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JAMA: http://jama.ama-assn.org
Study Try honey for childrens coughs
Tue, 04 Dec 2007 23:59:24 GMT
By CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A teaspoon of honey before bed seems to calm children's coughs and help them sleep better, according to a new study that relied on parents' reports of their children's symptoms.
The folk remedy did better than cough medicine or no treatment in a three-way comparison. Honey may work by coating and soothing an irritated throat, the study authors said.
"Many families are going to relate to these findings and say that grandma was right," said lead author Dr. Ian Paul of Pennsylvania State University's College of Medicine.
The research appears in December's Archives of Pediatrics and Adolescent Medicine
Federal health advisers have recently warned that over-the-counter cough and cold medicines shouldn't be used in children younger than 6, and manufacturers are taking some products for babies off the market.
Three pediatricians who read the study said they would tell parents seeking alternative remedies to try honey. They noted that honey should not be given to children under age 1 because of a rare but serious risk of botulism.
For the study, researchers recruited 105 children with upper respiratory infections from a clinic in Pennsylvania. Parents were given a paper bag with a dosing device inside. Some were empty. Some contained an age-appropriate dose of honey-flavored cough medicine containing dextromethorphan. And some contained a similar dose of honey.
The parents were asked about their children's sleep and cough symptoms, once before the bedtime treatment and once after. They rated the symptoms on a seven-point scale.
All of the children got better, but honey consistently scored best in parents' rating of their children's cough symptoms.
"Give them a little time and they'll get better," said Pat Jackson Allen, a professor at Yale University School of Nursing.
The study was funded by a grant from the National Honey Board, an industry-funded agency of the U.S. Department of Agriculture. The agency had no influence over the study design, data or results, Paul said.
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