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Doctors are continuing to prescribe a surfeit of antibiotics for treating sinus infections, although these drugs are not indicated in viral infections, according to a new study by researchers at the University of Nebraska Medical Center in Omaha. Antibiotics are medications that act against bacteria and not against viruses. The majority of sinus infections are viral in origin and hence antibiotics are rendered useless here.
The study, which reviewed two national studies, reveals that from 1999 and 2002 Americans made 17 million visits to healthcare facilities with complaints of sinus infection. Doctors prescribed antibiotics in at least 83 percent of acute sinusitis, while 70 percent of chronic sinusitis received prescriptions for the medications.
The details of the study appear in the March issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Sinus infections are typically classed as acute when symptoms continue to persist for at least a month, while they are chronic when symptoms last for three months of longer. Rhinosinusitis is an inflammation of the sinus cavities that line the nasal passages.
Sinusitis is a very common and an expensive medical condition in the United States, according to background information in the article. Around 21 percent of all antibiotics prescribed for adults in 2002 were for sinusitis, while 9 percent of all pediatric prescriptions were handed out to treat the condition.
“The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant and mucolytic agents, respectively,” the authors wrote in the paper.
Dr. Neil L. Kao, vice chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology said doctors could start off by determining if the sinus infection was bacterial in origin. Some of the common methods are by doing an endoscopy, nasal cytology or an X-ray.
But Dr Kao admitted these procedures were time consuming. " For us, even specialist doctors, when you see someone with acute nasal symptoms, it is hard to tell the cause. And the truth is that most of the people diagnosed with sinusitis go to primary care doctors," he added.
While the awareness of antibiotic resistance was increasing among American public, most patients demand antibiotics when they show signs of sinusitis like cough, drip and lack of sleep. Dr. Donald A. Leopold, chairman of the department of otolaryngology at the University of Nebraska Medical Center, who was a part of the study, said it was difficult for physicians to look beyond antibiotics.
"We as physicians don't have very good medications for chronic rhinosinusitis," he said. "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."
Overusing these unnecessary antibiotics is causing many drug-resistant bacterial strains to abound. These strains require costlier and newer antibiotics as treatment. But lead researcher Dr Hadley Sharp suggested most patients demand antibiotics.
Dr Leopold suggests that saline flushing is very useful in sinus infections. "It's a very old remedy, but something I think we physicians have forgotten," he said.
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