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Antibiotics have no effect on sinusitis, research finds

GPs are prescribing huge quantities of antibiotics unnecessarily in sinusitis, with new evidence suggesting they have little if any effect on the course of illness, researchers warn.

Use of amoxicillin has no benefit for acute sinusitis alone or in combination with a topical steroid, a Government-funded trial in 240 adults has concluded.

The GP researchers, whose preliminary results were first reported in Pulse in July last year, claimed the results should signal the end of antibiotic use in most patients with the illness.

A secondary finding was that use of the topical steroid budesonide seemed to have some effect in those with the mildest symptoms at baseline.

Study leader Dr Ian Williamson, senior lecturer in primary medical care at the University of Southampton and a GP in the city, told Pulse antibiotics were prescribed for sinusitis ‘by the bucketload' in the UK.

He said one possible reason for high levels of prescribing compared with other upper respiratory tract infections was conflicting results seen in recent studies.

‘We can be confident there's no useful effect from antibiotics, even in cases most likely to be due to bacterium.

‘In the typical cases a GP sees it will be even less likely to have an effect.'

He said patients would still need good symptom control with analgesics, but overcoming their high expectation for an antibiotic would be the hard part for GPs.

‘My advice would be to think twice – it's unlikely to have any benefit – and discuss it with the patient.'

Around 29% of patients had symptoms lasting 10 or more days if they were treated with for amoxicillin compared with 33.6% with no antibiotic and there was no difference between the budesonide groups.

Antibiotic prescribing for sinusitis may be as high as 92% in the UK, previous research has shown.

Professor Chris Butler, head of general practice at the University of Cardiff said: ‘This is an extremely well-conducted study that gives a clear answer.

‘It is true many GPs still prescribe antibiotics for things that patients and doctors call sinusitis but may not be sinusitis. Even with symptoms that are highly suggestive – antibiotics are unlikely to help.'

Researchers studied 240 patients with acute sinusitis from 58 practices.

Patients were randomised to 500mg of amoxicillin three times per day for seven days, 200µg of budesonide in each nostril once per day for 10 days, placebo versions of both and all combinations.

Neither amoxicillin or topical steroid, alone or in combination, were found to be effective.

The study was published in Jama

The studyThe study The study

Researchers studied 240 patients with acute sinusitis from 58 practices.

Patients were randomised to 500mg of amoxicillin three times per day for seven days, 200µg of budesonide in each nostril once per day for 10 days, placebo versions of both and all combinations.

- Neither amoxicillin or topical steroid, alone or in combination, were found to be effective.

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