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Antibiotics Are Useless In Treating Most Sinus Infections

timothy posted more than 2 years ago | from the coulda-told-you-that dept.

Medicine 377

An anonymous reader writes "While doctors routinely prescribe antibiotics to treat sinus infections, researchers on Tuesday revealed that amoxicillin, the most commonly prescribed medication for nasal cavity inflammation and sinuses, was just as effective as a dummy pill. Researchers from the Washington University School of Medicine in St. Louis, Missouri, found that there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."

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What does this sentence mean? (3, Insightful)

fredrated (639554) | more than 2 years ago | (#39060393)

"there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."

Re:What does this sentence mean? (4, Informative)

compro01 (777531) | more than 2 years ago | (#39060449)

Each group started on their pills and they checked for effect 3 days later.

Re:What does this sentence mean? (1)

jeesis (2494876) | more than 2 years ago | (#39060463)

Anti-biotics take more than a few days to work?

Re:What does this sentence mean? (5, Insightful)

troc (3606) | more than 2 years ago | (#39060621)

Antibiotics are very quick - their major effect is in the first couple of days of a 10 day (2 week, whatever) course. The extra week or more of pills is to make absulutely sure that everything that can be killed off, is. This is to prevent (or at least restrict) the chance of any drug-resistant strains developing.

One of the major problems in countries like France (where drugs are handed out like sweets) and in the developing world (where people can't afford the whole course, or save some for "next time") is people not finishing up a full course of antibiotics because 3 days in, they feel well and can't see the need to swallow any more of the evil pills that have given them diarrhoea and other stomach problems (the main side effect of broad spectrum antibiotics....).

Re:What does this sentence mean? (4, Insightful)

i.r.id10t (595143) | more than 2 years ago | (#39060675)

Which is why you should eat active yogurt cultures when you are on antibiotics ...

Re:What does this sentence mean? (1, Interesting)

Dogbertius (1333565) | more than 2 years ago | (#39060791)

Simple solution: Don't give them any to take home. Make them come over to the clinic for their daily dose. Or use some simple syringe device with a counter built into it with replaceable needles that they can take home, but eventually have to return to the clinic. You don't finish the course in a country like France, you get fined a couple grand. In a place where fines wouldn't work, just don't give them the next course of drugs when they get sick again. Should remedy the situation rather quickly.

Stupid and irresponsible people make the world difficult to live in. Please stop with your irrational behavior.

slashdot title also written by a moron (4, Insightful)

rubycodez (864176) | more than 2 years ago | (#39060473)

amoxicillin, because there are no other antibiotics on planet earth.

yeah focus on symptoms, because progression of infection is irrelevant. three days, because all antibiotics cure by monday morning if course started friday morning

Re:slashdot title also written by a moron (0)

Anonymous Coward | more than 2 years ago | (#39060687)

They say on the 7th day the antibiotic users feel better than placebo users. So sounds like the antibiotic takes more than 3 days to work, and by 10 days the infection is usually cured even without antibiotics.

Re:slashdot title also written by a moron (4, Informative)

rwven (663186) | more than 2 years ago | (#39060793)

My thought exactly. Clindamycin and Biaxin are especially good at treating sinus infections. Why they used a drug like amoxicillin is beyond me...

Re:slashdot title also written by a moron (1)

X0563511 (793323) | more than 2 years ago | (#39061409)

Allergies, perhaps?

Though in my case it's the *cillin family I'm allergic to, so I need the alternatives.

Re:slashdot title also written by a moron (2)

sjames (1099) | more than 2 years ago | (#39061491)

No, amoxicillin because that is by far the most common prescription for sinus infections. It makes sense to see if that's actually helping, doesn't it? Now that we know it isn't, we know we need to consider either no prescription or a different one. We can then do studies to see how that works out.

Re:What does this sentence mean? (0)

Anonymous Coward | more than 2 years ago | (#39060497)

They were statistically unable to determine whether any observed difference in symptoms were due to the difference in treatment or simply chance.

https://en.wikipedia.org/wiki/Statistical_significance [wikipedia.org]

quacks (5, Interesting)

v1 (525388) | more than 2 years ago | (#39061487)

I inherited bad sinuses from my mother who occasionally gets wicked sinus infections and has to go on hardcore antibiotics, the kind that WIPE your digestive tract and turn your poo white.

Fortunately for me genetics diluted the problem and I don't get one more than once a year usually. I've tried to tough it out, load up on decongestants and expectorants (due to drainage) etc and all that happens is it gets my throat torn up like hamburger from the infected runoff combined with coughing. Lucky me, I'm going through my yearly round of that right now actually. I started myself on decongestants immediately and have been pounding down pepsi almost nonstop to try to keep my sinuses and throat clear, but it still looks like the throat version of red-eye in there. I might actually beat it without antibiotics for the first time this time since I've jumped on it so aggressively.

In the past it's usually been the same story. Try to use over-the-counter meds for a week, finally it is getting so bad that the yellow mucus overnight has my throat destroyed by morning. (which will improve somewhat during the day, but not enough, it's a losing battle day to night) Enough of those and I can't stop coughing and I sprint into the local "convenient care" before work and a random doc looks at me and prescribes a decongestant and expectorant (that cost 2x the OTC usually) saying he doesn't want to give me antibiotics YET. Thanks.

So I'm back in the office 3-4 day later, almost unable to talk, haven't slept in days, throat killing me, and throat is totally red with green mucus streaking down in the back. "Ooooh! you have a bad sinus infection now! Here's some antibiotics!" Thanks. Now why couldn't we have just done this three days ago instead of putting me through two days of hell?

So the last two times I went in I relayed the above story and they conceded maybe antibiotics before it gets REALLY bad is a good plan for me. And I was sooo thankful, instead of it taking several more days of winding down misery, another two weeks in all, one round of refills to clear up, it was much better the very next day and cleared up in 5 days, both times.

Whoever says antibiotics don't help sinus infections is a quack. I seriously wonder what would happen to people like me if there were no antibiotics, could it get bad enough to hospitalize or kill me?

Re:What does this sentence mean? (1)

Zandamesh (1689334) | more than 2 years ago | (#39060531)

"there was no significant difference in symptoms between patients taking amoxicillin to those who took the placebo three days after starting the pills were administered."


there was no significant difference
        in symptoms
                between patients taking amoxicillin to those who took the placebo
three days
        after starting the pills were administered.

Humans are bad at understanding nested stuff, luckily for me, I'm a programmer.

Re:What does this sentence mean? (2)

CSMoran (1577071) | more than 2 years ago | (#39061269)

Humans are bad at understanding nested stuff, luckily for me, I'm a programmer.

You're definitely not a compiler -- you missed the syntax error at the end of the original sentence...

Re:What does this sentence mean? (1)

X0563511 (793323) | more than 2 years ago | (#39061433)

Hrm, it would be interesting if a compiler could detect simple stupid mistakes and bitch about them, and then proceed to build correctly. Though that would be done in preprocessing right?

Yo dawg, i heard you like compiling, so I put a compiler in your compiler...

Sinus infections don't last long enough? (1)

Shivetya (243324) | more than 2 years ago | (#39060537)

In most cases?

Most likely, there was no measurable change between the two groups. I have had all sorts of antibiotics prescribed to me for various issues, amoxicillin is only given in the least annoying conditions by my doctor. I have done the zpacs (amoxicillin), cefalexin, and in one case I had cipro (which I will not wish on anyone, it worked but side effects were not fun and it was not for a sinus infection)

I have pretty much gotten away from drugs for a sinus infection unless it doesn't seem to sort itself out quickly. Not sure if that is good or bad, but I haven't had as many since I stopped trying to treat them with antibiotics.

I would RTFA to find out what they did to insure parity among control groups... but... its more fun to post

Re:Sinus infections don't last long enough? (1)

Anonymous Coward | more than 2 years ago | (#39060837)

and in one case I had cipro

All I can figure based on the above post, and especially this part, is you work in a class 5 biocontainment lab and some of the anthrax got in your suit.

Re:Sinus infections don't last long enough? (0)

Anonymous Coward | more than 2 years ago | (#39061097)

A basic kidney/bladder/urinary tract or ear or sinus infection that is not cured after the round of Augmentin will often get you onto the slightly harder stuff. And if they think you could have anything nasty like a minor intestinal leak, they'll put you on cipro. So if Shivetya has had abdominal problems of unknown origin, that could easily lead to those medications without a biocontainment lab.

Re:Sinus infections don't last long enough? (0)

Anonymous Coward | more than 2 years ago | (#39060927)

I have done the zpacs (amoxicillin)

You mean azithromycin

Re:What does this sentence mean? (1)

Anonymous Coward | more than 2 years ago | (#39060861)

It means that you should eat tic tacs if you have a sinus infection. They work just as well as amoxicillin.

This isn't news... (-1)

Anonymous Coward | more than 2 years ago | (#39060409)

to those of us who get sinus infections every few months. Another common trick they use to keep you sick is perscribing too short a course of AB to actually kill it off, so it comes back with a vengeance a month or two later -- nice and AB immune.

my favorite sinus remedy: simple, cheap (5, Interesting)

nido (102070) | more than 2 years ago | (#39060655)

Doctors have a tendency to recommend things that only they can recommend: prescription drugs, surgery, etc. They figure if you could do it yourself you'd have already done it.

But there's an ancient treatment for sinus problems that works really well: nasal irrigation [wikipedia.org] . Basically, you add 1/2 tsp salt to a cup of water, and flush that through your nasal cavity.

Wall Street's media was overjoyed when someone with parasites in their water supply recently died after they used their neti pot. So boil your water first if that's a problem where you live, mkay? (This is covered on the link above...)

Re:my favorite sinus remedy: simple, cheap (1)

jgtg32a (1173373) | more than 2 years ago | (#39060847)

I'd also advise using a brita filter or something, then again I have the most ridiculous hard water in my apartment. I sponge down my bathroom walls every month to get rid of the yellow streaks.

Re:my favorite sinus remedy: simple, cheap (3, Interesting)

Andy Dodd (701) | more than 2 years ago | (#39060871)

This is how I beat well over half of the sinus infections I get - nasal irrigation works great.

However, sometimes the infection is stubborn and it resists 1-2 weeks of irrigation, staying in a steady state of no improvement. At that point I'll usually give in and start antibiotics, and with one exception (Normally my infections are triggered by normal colds initially, or allergies, in this case one of my peak allergy periods occurred two weeks AFTER the initial infection trigger, which was sewage-laden dust from the September 2011 Susquehanna flooding), they have always cleared up the infection in only a day or so.

I think the problem is that in the article given, the doctors in question are probably starting the antibiotics too early - if it's the first few days of "infection" it's very difficult to separate viral causes (just a cold), allergic causes, and actual bacterial causes. Now if you're at nearly 2 weeks of routine nasal irrigation and you have frequent bright yellow discharge restart 2-3 hours after you irrigate - at that point it's much more likely to be bacterial.

Re:my favorite sinus remedy: simple, cheap (2, Informative)

Anonymous Coward | more than 2 years ago | (#39060975)

Except they don't really work for infections. By the time you're feeling symptoms of a sinus infection, it's already in your bloodstream, you can't just wash it away by pouring water up your nose. Now, it's not to say they're worthless, especially if you use them on a regular basis. The reason sinus infections are so common is that the mucus in your nose provides an ideal environment for bacteria to grow. Since a colony can grow in the mucus in peace (there are no white blood cells in snot), it can get quite strong before it enters the bloodstream, at which point it's too late for your body to easily and quickly fight off. Nasal irrigation can also help with recurrence, since it's possible for a bacterial colony to take hold in your nose, and essentially keep reintroducing itself back into the bloodstream as your body fights it off. What nasal irrigation can't do though is actually fight off an infection. The congestion and runny nose associated with a sinus infection are symptoms, not the infection itself, which is in your bloodstream, and requires either natural antibodies or antibiotics to cure.

Re:my favorite sinus remedy: simple, cheap (1, Informative)

Nimey (114278) | more than 2 years ago | (#39061217)

Except that improperly-done nasal irrigation can kill. There were a couple people in Louisiana who used tap water to irrigate their sinuses, but the water was infected with an amoeba that killed them.

Ought to use distilled water for that at the least.

What does work? (3, Funny)

svendsen (1029716) | more than 2 years ago | (#39060415)

Whiskey!

Re:What does work? (0)

Anonymous Coward | more than 2 years ago | (#39060529)

But only if you snort it 3 times a day. And man, the looks you get at work in the bathroom snorting whiskey...

Re:What does work? (0)

Anonymous Coward | more than 2 years ago | (#39060571)

As an allergy sufferer, there is a homeopathic spray of Capsicum and menthol called Sinus Buster! that works wonders--if you can get over the shock of spraying weak pepper spray up your nose.

Re:What does work? (0)

Anonymous Coward | more than 2 years ago | (#39060725)

It'd be a stretch to call Sinus Buster "homeopathic" -- it's 0.1% capsaicin. Which is considerably more than, say, Tabasco sauce.

Re:What does work? (1)

FictionPimp (712802) | more than 2 years ago | (#39060739)

If you can feel the capsicum then it's not homeopathic.

Homeopathic = water as medicine. So if it was homeopathic you would be spraying water up your nose.

Re:What does work? (1)

cyberchondriac (456626) | more than 2 years ago | (#39061477)

/\ This.
If it were homeopathic, it wouldn't have 0.1% capsaicin, it'd have something like 0.00000001% capsaicin.
To be honest, I can consider feasible many things that aren't currently backed by scientific evidence, but homeopathy ain't one of them. I don't know how it's advocates can say that the more diluted something is, the stronger it is, with straight face.

Re:What does work? (1)

Andy Dodd (701) | more than 2 years ago | (#39060905)

I originally thought this was great - I took it, and almost immediately saw yellow drainage.

Well, after a while I've figured out - the stuff itself is yellow and was not promoting any significant drainage. It turns out I get FAR better results from eating spicy food (like hot salsa and chips) than snorting a special capsaicin preparation like Sinus Buster - no clue why, it is somewhat counterintuitive.

Re:What does work? (1)

Panaflex (13191) | more than 2 years ago | (#39061125)

Agreed - during my worst sinus infections I crave Thai food and horseradish.

The only thing medicinally that has worked for me is the cortisone shot, but that's not a viable long-term solution.

Re:What does work? (2)

fuzzyfuzzyfungus (1223518) | more than 2 years ago | (#39061027)

Assuming the labeling is following conventions for homeopathic dilution notation, I'm not surprised that that stuff would clear your sinuses good and hard, and not because of my boundless confidence in homeopathy...

A '3x' dilution is three successive 1:10 dilutions of the substance indicated in some neutral solvent. "Capsicum 3x" would be .1% capsaicin. Not exactly riot-cop stuff; but it'll definitely give you a bit of a kick. The unspecificed amount of Eucalyptol will likely get the sinuses cleared out as well...

There is, of course, nothing wrong with using plant-derived compounds that cure what ails you(that and sharp objects were, after all, basically the whole of medicine until the chemists really started to gear up in the late 19th and 20th century...); but the marketing as 'homeopathic' of drugs with concentrations well in the conventionally active range always annoys me.

Re:What does work? (1)

Anonymous Coward | more than 2 years ago | (#39060645)

Source? ...I'm genuinely curious as I like whisky and dislike sinus infections...

Biofilms (5, Insightful)

tmosley (996283) | more than 2 years ago | (#39060447)

You can't effectively treat biofilms with antibiotics. And that is exactly what this type of infection is--a biofilm.

A better approach is the use of biofilm "release" enzymes that signal the cells within the biofilm to stop producing EPS and detach from whatever surface they are clinging to. Use of such enzymes alongside antibiotics in a medical setting is likely to work even better.

Re:Biofilms (0)

Anonymous Coward | more than 2 years ago | (#39060665)

Care to cite that claim?

Re:Biofilms (4, Informative)

tmosley (996283) | more than 2 years ago | (#39061091)

Certainly. In addition to research performed by my own research group, the "Big Daddy" of biofilm research is Bill Costerton. His group puts out oodles of papers on the subject. This was merely the first that popped up in a Google Scholar search, though it is one that we have referenced for our own publications: http://www.sciencedirect.com/science/article/pii/S0140673601053211 [sciencedirect.com]

Re:Biofilms (0)

Anonymous Coward | more than 2 years ago | (#39061361)

Sure you are... Ted Mosley!!! you're merely an archi- wait for it..... tect not a researcher of biofilm!!!

Re:Biofilms (1)

tmosley (996283) | more than 2 years ago | (#39061623)

My name isn't Ted. I was a student of architecture before I switched to chemistry when I was in college, though.

Re:Biofilms (1)

fuzzyfuzzyfungus (1223518) | more than 2 years ago | (#39061311)

This one [calstatela.edu] is conveniently not-paywalled. Research on how exactly to kill the bastards(at least in environments such as whiny humans where expedients like "fire", "brutal doses of ozone", and similar reliable methods are disallowed) is ongoing; but it is apparently the case that a bacterial biofilm exhibits something approaching multicellular cooperation in surviving antibiotics. You can certainly cull the weak and the surface layer; but some combination of near-dormant sleeper cells and novel multi-cellular resistance mechanisms makes eradicating them very difficult indeed.

Re:Biofilms (2)

BlueParrot (965239) | more than 2 years ago | (#39060841)

I'm by no means an expert in the field, but wouldn't that increase the risk of sepsis for some types of infections? I mean, the last thing you want is for the bacteria to start spreading throughout the circulatory system, and telling them to split up and release seems like it might do just that.

Re:Biofilms (4, Informative)

tmosley (996283) | more than 2 years ago | (#39061189)

That is why you combine the treatment with antibiotics. Planktonic bacteria are highly susceptible to all manner of natural and artificial defenses. If the area has the release enzyme in place, then they won't settle on a surface and start growing. The body can deal with individual bacteria in the bloodstream pretty easily. It's likely clots of biofilm that cause problems.

Re:Biofilms (2)

ackthpt (218170) | more than 2 years ago | (#39061025)

You can't effectively treat biofilms with antibiotics. And that is exactly what this type of infection is--a biofilm.

A better approach is the use of biofilm "release" enzymes that signal the cells within the biofilm to stop producing EPS and detach from whatever surface they are clinging to. Use of such enzymes alongside antibiotics in a medical setting is likely to work even better.

I just eat spicy food (liberal use of capsicums.) My body reaction is to produce more sinus mucus. Seems to work, not enirely certain how, though perhaps someone more informed on what the increase does .. though it is worth noting most of these infections coincide with winter and thus drier air. Keeping sinus from drying or keeping the mucus in productions appears to limit spread and duration of infections (though could this be how the body is meant to work?)

Re:Biofilms (2)

tmosley (996283) | more than 2 years ago | (#39061277)

Sounds dumb, but it's actually highly effective. Unless the tissue itself is compromised (it always will be to some extent), the mucus production will float the infected mass away and confine it. It is also helpful to use a neti pot (clean water please), as that will wash away anything that is physically jammed in your upper sinuses. That is personal experience, not a course advised by systematic studies (my lab does only in vitro and animal work).

Re:Biofilms (2)

Pharmboy (216950) | more than 2 years ago | (#39061483)

Take two dozen spicy wings, drink lots of fluids, and call me in the morning.

Yes, it does work well from my experiences. I eat a lot of spicy food anyway, but ramping it up with lots of water does seem to open up the head. Capsicums are irritants (tasty irritants) that make your sinuses want to float them out. As long as you drink plenty of water with them, your body will do the rest. Not sure about a major sinus infection, but it surely works great on the typically stuffy head syndrome that I get often enough in the winter.

Lets make Antibiotics obsolete (1)

realsilly (186931) | more than 2 years ago | (#39060459)

We've known for years that Doctors have over prescribed Antibiotics for many ailments, simply because people just don't want to feel miserable when they get sick. And since most people can't afford time off of work they don't take it or won't take it for fear of the backlash from a company, people still go to work and infect others and the cycle continues. The cheap solution is to take pills instead to resolve the immediate illness.

Re:Lets make Antibiotics obsolete (4, Interesting)

khb (266593) | more than 2 years ago | (#39060569)

Unfortunately some people need them. My son hearing loss is ascribed to under treatment of sinus infections

Few doctors use an endoscope to examine and sample the nasal passages. So they prescribe blind. That is what's ineffective. When they can see and sample the pus diagnosis and choice of an antibiotic suitable for the specific pathogen is reliable.

Pity the paper didn't point out the effective course of treatment, focusing solely on the known (but common) ineffective approach.

Re:Lets make Antibiotics obsolete (0, Flamebait)

geekoid (135745) | more than 2 years ago | (#39060657)

We've known for years that Doctors have over prescribed Antibiotics for many ailments,

NO WE DO NOT KNOW THAT, please shut the fuck up and keep your popular culture non science views to your self, asshole.,
"simply because people just don't want to feel miserable when they get sick."
What we have hear is an ignorant mother fucker who has lived in a world with antibiotics and has no clue what life was like before them.

Re:Lets make Antibiotics obsolete (4, Insightful)

BlueParrot (965239) | more than 2 years ago | (#39060971)

What we have hear is an ignorant mother fucker who has lived in a world with antibiotics and has no clue what life was like before them.

Which is exactly what you will get if antibiotics are over prescribed. Just look at what happened in countries that don't have effective regulations for medicines, like India. They're starting to see cases of tuberculosis that are resistant to ALL antibiotics, making it untreatable. When untreated TB kills 50% of patients.

Antibiotics are very useful, but they absolutely need to be used responsibly to minimise the risk of resistant infections. I'd argue abuse of antibiotics is even more troublesome than recreational drugs, since with antibiotic resistant infections the illnesses can then spread to other people, or even the whole world, causing severe damage that no narcotic could ever match.

Re:Lets make Antibiotics obsolete (2)

tmosley (996283) | more than 2 years ago | (#39061425)

Antibiotics are fast going the way of the dodo. Phage is the future. Bacteriophages can be (and are) subjected to artificial evolution in small clinics to kill any strain of bacteria, no side effects, no long term resistance, no multibillion dollar research needed.

And that doesn't even mention new methods of drug design coming down the pike.

But you are exactly right, while those treatments are developed/gain acceptance in the West (phage therapy was originally developed in the nation of Georgia prior to the Soviet conquest), we must avoid antibiotic resistance. It should simply be noted that there are alternative technologies out there.

Re:Lets make Antibiotics obsolete (1)

Anonymous Coward | more than 2 years ago | (#39060985)

You disagree with the poster, that is fine, but to degrade your intellect with such vulgar language against a point of discussion in a forum shows that you have no care to be educated beyond your own ignorance. Kudos on displaying it so profoundly. /golfclap

Re:Lets make Antibiotics obsolete (0)

Anonymous Coward | more than 2 years ago | (#39061053)

Yeah we do. I've even had conversations with my doctor -- "Are you sure I need this antibiotic?" "No, not really." Then he decides I don't.

Re:Lets make Antibiotics obsolete (1)

realsilly (186931) | more than 2 years ago | (#39061365)

We've known for years that Doctors have over prescribed Antibiotics for many ailments,

NO WE DO NOT KNOW THAT, please shut the fuck up and keep your popular culture non science views to your self, asshole.,
"simply because people just don't want to feel miserable when they get sick."
What we have hear is an ignorant mother fucker who has lived in a world with antibiotics and has no clue what life was like before them.

Wow, you're such a sweet-talker. Do you kiss your mother with those lips? And if you do I hope you sterilize them first.

Re:Lets make Antibiotics obsolete (2, Informative)

Anonymous Coward | more than 2 years ago | (#39061435)

We've known for years that Doctors have over prescribed Antibiotics for many ailments,

NO WE DO NOT KNOW THAT, please shut the fuck up and keep your popular culture non science views to your self, asshole.,

I guess the Harvard Medical School and the Harvard School of Public Health are now qualifying as non-science, huh
http://www.news.harvard.edu/gazette/2005/11.10/11-sore.html [harvard.edu]

Or how about this study, in which 44% of doctors "admitted sometimes prescribing antibiotics to patients who may not need them"
http://www.ncbi.nlm.nih.gov/pubmed/18196886 [nih.gov]

Re:Lets make Antibiotics obsolete (1)

tmosley (996283) | more than 2 years ago | (#39061317)

For such problems, phage is likely a better treatment. An old friend of mine is working on introducing therapeutic phage to America. His results are quite stunning.

Re:Lets make Antibiotics obsolete (1)

sjames (1099) | more than 2 years ago | (#39061639)

I suspect it won't get any better until we make sick pay (or telework days) mandatory. Until then, there are simply too many people who literally can't afford to be sick and are forced to show up fro work even if they carry the plague. Ultimately, it probably costs the economy a lot more than it saves. It also maximizes our chances for a pandemic.

To be fair, this shouldn't be yet another unfunded mandate.

Here's a link to the actual study at JAMA's site (3, Informative)

stillnotelf (1476907) | more than 2 years ago | (#39060495)

http://jama.ama-assn.org/content/307/7/685.short [ama-assn.org] I can't tell if it's paywalled or not - it appears to be. Pubmed hasn't indexed it yet (not that they offer free articles from JAMA anyway).

Re:Here's a link to the actual study at JAMA's sit (5, Informative)

stillnotelf (1476907) | more than 2 years ago | (#39060615)

Here are some interesting points from the paper:

A) Someone's got a sense of humor: "The primary outcome was measured using the modified Sinonasal Outcome Test-16 (SNOT-16), a validated and responsive measure."

B) They did no testing whatsoever to ensure the sinus infections _were_ bacterial - but they apparently usually are, and are usually diagnosed as such symptomatically instead of by culture (in other words, they followed normal practices in deciding who to give antibiotics to).

C) They did no testing to see if resistant bacteria could be isolated from any patients.

Putting B and C together...clearly the medical community is overprescribing antibiotics, but there may be some question of whether it's resistant bacterial infections or poor diagnosis of bacterial vs. viral infections.

Obvious... (5, Insightful)

Covalent (1001277) | more than 2 years ago | (#39060521)

Most sinus infections are viral. Nothing to see here.

Re:Obvious... (2)

stillnotelf (1476907) | more than 2 years ago | (#39060643)

From the paper: "All study participants met the recommended clinical criteria for acute rhinosinusitis[1] and are representative of patients for whom antibiotics might be prescribed." [1] is Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande MA, American Academy of Family Physicians; American College of Physicians-American Society of Internal Mediciine; Centers for Disease Control; Infectious Diseases Society of America. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med. 2001;134(6):498–505.

Re:Obvious... (1)

AtomicJake (795218) | more than 2 years ago | (#39060811)

OP is correct, though. Troublesome to see a rather recent publication (2001) giving the wrong advice for such a "standard" disease.

Re:Obvious... (3, Informative)

level_headed_midwest (888889) | more than 2 years ago | (#39061593)

You are both right. Most sinus infections are viral, and many patients with viral sinus infections demand that the doctor "do something," which generally means they want antibiotics. Many times they still demand antibiotics even though the doctor explains that antibiotics will not work for their *viral* infection. Thus anybody with sinusitis, be it viral or bacterial, is somebody who "might" be prescribed antibiotics.

Re:Obvious...Complications... (3, Insightful)

BoRegardless (721219) | more than 2 years ago | (#39061133)

It is entirely possible for a virus to give tissue damage that then results in a bacterial infection or visa versa!

Hence, I can easily believe that a rhinovirus could easily prevent clearing up a sinus infection with bacteria.

Biofilms, as mentioned by others, may also be an important variable.

It is anything but simple "Yes or No."

The Solution (0)

Anonymous Coward | more than 2 years ago | (#39060523)

Don't use antibiotis for treating sinus infections!

that's amoxicillin (1)

buddyglass (925859) | more than 2 years ago | (#39060547)

Azithromycin (in the form of a Tri-Pak [drugs.com] ) sure seems to make a dent in my sinus/bronchial infections.

Re:that's amoxicillin (1)

Joehonkie (665142) | more than 2 years ago | (#39060603)

Have you compared it in a double-blind test to placebo?

Old news but it still has be said. (1)

Anonymous Coward | more than 2 years ago | (#39060561)

However; when you have dark green stuff coming out of your nose and you coughing jello from deep inside your lungs, you might qualify for some good antibiotics. For milder stuff, docs recommend rest and over counter stuff. Sometimes a breathing treatment can help. Let's hope you have insurance?

Over-extapolating (5, Insightful)

wonderboss (952111) | more than 2 years ago | (#39060573)

Big leap from "no significant difference in symptoms between patients taking amoxicillin to those who took the placebo"
to "Antibiotics Are Useless In Treating Most Sinus Infections". How many bugs are resistant to amoxicillin at this point?
How many of the patients had bacterial infections?

allergic to antibiotics (0)

Anonymous Coward | more than 2 years ago | (#39060587)

35 years without antibiotics treatment and i'm still alive & kicking, in fact it's been 8 years since I had to stay home due to illness.
Gimme a placebo (or even better a good whisky) and I'll be fine, gimme antibiotics and I'll actually need a hospital.

inaccurate summary (4, Insightful)

cinnamon colbert (732724) | more than 2 years ago | (#39060605)

abstract is here http://jama.ama-assn.org/content/307/7/685.abstract [ama-assn.org]
story itself, paid for probably with tax dollars is paywalled
The abstract says that yes, at 3 days, amoxicillin and placebo similar, but there was a diff at day 6
Also, total number of patients studied is quite small - Typical Bull**** "MD" science - mds just don't know how to do science, and they constantly flood the literature with these worthless studies, so the net result is a negative, cause you have towaste brain power to not pay attention

However, what is of more interest is the hard to read format of the abstract, which is a deliberate format imposed by the medical journals; the use of statistics in parenthesis, eg quote, mean difference between groups of 0.03 [95% CI, 0.12 to 0.19]) and on day 10 (mean difference between groups of 0.01 [95% CI, 0.13 to 0.15]), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19 [95% CI, 0.024 to 0.35]).
makes the abstract almost impossible to read; this practice has been criticized, but the idiot mds of course don't listen.
Not only that, with the number of people in the study, if you know naything of the history of medical studies, to give CIs is just BS, crazy statistics for no reason other then to tget a publication or satisfy the wierdness of hte editors; everything that is wrong with academic medicine is in this abstract
sorry for rant

Re:inaccurate summary (1)

tibit (1762298) | more than 2 years ago | (#39060807)

I wish you weren't right, but right you are. 166 adults, haha. Anyway, I love the cut-off conclusion. What they say:

Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment.

What they meant to say: Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment. The symptoms were reduced at day 7 of treatment. Another important point: if the symptoms appear to be reduced at day 7, but not reduced at days 3 and 10, then you may wish to question the test you're using (SNOT-16 in their case), or your sample size. I wouldn't want my name on this paper with less than ~630 adults.

Nope (5, Insightful)

geekoid (135745) | more than 2 years ago | (#39060627)

THE AC submission was alarmist and wrong.

The research did not show the anitbiotics are useless.

It showed the Amoxicillin had no significant statistical difference at day three. BUT statistically significant results on day 7, no difference on day 10.

What this means is the people taking Amoxicillin got better sooner.

The person who wrote the headline and summary should be ashamed of themselves.

Re:Nope (0)

Anonymous Coward | more than 2 years ago | (#39061373)

Agreed, however as a physician I will say you defintiely need to observe the large number of "studies" of insufficient power, or with overt selection bias being passed into the mainstream media that "show" how medical treatments are ineffective or that certain screening studies are not needed.

Why is this? Because as the governments begin to be the primary PAYER for medical care their concern is for their budgets and not the patient.
They could not care less if your head aches for an additional 72 hours if you don't take the antibiotics, but they DO care that they can save $10 on meds for the million or so people diagnosed with this probably daily.

Be very aware of these new efforts to subvert the publics oppinion of medical care. Too much has already been subverted as can be seen by the response even in this thread.

Follow the money,

Common Cold (1)

TheNinjaroach (878876) | more than 2 years ago | (#39060691)

This is no different than the common cold, 90% of which come from a virus instead of bacteria.

Re:Common Cold (1)

Oswald McWeany (2428506) | more than 2 years ago | (#39060921)

I read a few months back about anti-viral medicines in the works that could end up being a effective against wide-ranges of viruses as anti-biotics are against bacteria.

Could be revolutionary if true. Until virus evolve to resist them at least.

that sucks (2)

james_van (2241758) | more than 2 years ago | (#39060713)

i currently a) have a sinus infection, b) am taking amoxicillin to treat it, and c) am completely miserable. hey science, thanks for making my day even worse!

Re:that sucks (0)

Anonymous Coward | more than 2 years ago | (#39060863)

Don't worry, your next week will be better since the study says you'll probably be better than the untreated group by day 7.

Welcome to lifehacker.com (0)

michaelmalak (91262) | more than 2 years ago | (#39060733)

Welcome to lifehacker.com

Wrong antibiotic (0)

Anonymous Coward | more than 2 years ago | (#39060849)

At least it's not effective for me. Let me know when they do a trial of Azithromycin.

That said, I've found sniffing water way up into my sinuses to be similarly effective, if extremely painful and potentially deadly if done wrong [slashdot.org] .

I want a Placebo (4, Funny)

Oswald McWeany (2428506) | more than 2 years ago | (#39060857)

Can someone tell me where I can buy a pack of placebos please?

They seem to be really usefull in fighting off all sorts of diseases.

Re:I want a Placebo (1)

ZombieBraintrust (1685608) | more than 2 years ago | (#39061371)

Can someone tell me where I can buy a pack of placebos please?

They seem to be really usefull in fighting off all sorts of diseases.

You can buy Pez brand placebos at some grocery stores. They come in a rather inventive storage devise.

Re:I want a Placebo (1)

Oswald McWeany (2428506) | more than 2 years ago | (#39061459)

Awesome- I've seen them.

Do you happen to know if Lightning McQueen or Dorothy from Wizard of Oz works best at combating cancer?

Re:I want a Placebo (5, Funny)

Hentes (2461350) | more than 2 years ago | (#39061377)

Just ask for homeopathic medicine.

Fully loaded with bullcrap (-1)

Anonymous Coward | more than 2 years ago | (#39060929)

Original study at http://jama.ama-assn.org/content/307/7/685.short says that there was a difference at day 7, since the experiment is a 10 day experiment.

Even if so, that Amoxicillin doesn't works, doesn't means all antibiotics don't work. Then again, most of these infections come from viruses. The study was of a too small scope to show if there was a relationship with complications. The original article says that 92% of the people also used other treatments. All in all, this is bullshit. It seems like it was done by students as a requirement.

All of this is very obvious if you check the source. I guess that slashdot is buying into sensationalism, I have a post in front of my face that is spam (but since mods and admins only check posts with a high score, that post is going to be there forever ), slashdot is slow to post news, and it's not attracting new people. The page design is thankfully something left by the former glory of slashdot, but will eventually get old and not get fixed. The only reason to come here are the discussions with people who are slashdot regulars, but I'm pretty sure that just like me, they will move to better places.

Slashdot is a shade of it's former self.

Re:Fully loaded with bullcrap (1)

tmosley (996283) | more than 2 years ago | (#39061589)

20% of patients continued to have symptoms after ten days in each case, by my reading. This indicates to me the formation of a strong biofilm, which antibiotics will be next to useless against.

Also, slashdot was never great. It's not much different now than it has been for the last ten years, except that now there are a lot fewer dupe articles.

Question (1)

DaMattster (977781) | more than 2 years ago | (#39061033)

Are antibiotics ineffective on sinus infections because the infection is viral and not bacterial or could it be that the common bacteria responsible for such an infection has grown resistant to the antibiotic?

No effect after three days (0)

Anonymous Coward | more than 2 years ago | (#39061131)

Which might be why my doctor told me it takes 21 days of antibiotics to get rid of a sinus infection. As I had not been on antibiotics in over ten years, I took them for 21 days and cured my sinus infection. Befor eI had them prescribed I did ever natural remedy I was offered, nasal rinses, steroid nasal sprays, decongestants.
Within a week of starting the antibiotics there was a noticable change in what was coming out of my nose, nd after 21 days no more color in the phlegm (sign of infection).
Antibiotics over prescirbed are a bad thing, but reactionary pseudo journalism does not help.

Mayo clinic: most are viral (5, Interesting)

Bhrian (531263) | more than 2 years ago | (#39061309)

A Mayo clinic study found 70% of sinus infections are viral instead of bacterial, so antibiotics actually make the infection worse. In addition, the antibiotics harm the rest of your immune system, leaving your worse off than before. My ENT introduced me to anti-viral nasal sprays for sinus infections. More of the drug reaches the infection and your GI system is left unharmed. The catch is they must be compounded at a pharmacy, need to be refrigerated, and are only good for 30 days. Many insurance companies cover them, but a lot of doctors don't know that option exists and just prescribe antibiotics.

Yes but (1)

aglider (2435074) | more than 2 years ago | (#39061331)

the antibyotics factories have a different view. Very different.

Interesting. I was diagnosed last week... (0)

Anonymous Coward | more than 2 years ago | (#39061335)

... with a sinus infection and given generic amox for it.

Could well be coincidental timing, but I'd been getting steadily worse up until going on the antibiotics, and started getting better within 12 hours afterwards...

Kids vs Adults? (1)

jdev (227251) | more than 2 years ago | (#39061363)

I noticed this study was only conducted on adults. I'd be curious if the results would be replicated in children as well. When my kids were younger, they had sinus infections at least twice a year and would get amoxicillin every time. If a sinus infection would clear up on its own about as fast, there wouldn't have been as much need for the constant doctor visits.

The article says sinus infections account for 20% of all antibiotics prescribed for adults. I'd be surprised if that number wasn't over 50% for kids. Not using antibiotics for sinus infections would be a huge help in reducing antibiotics use. On the other hand, it would probably be devastating for pediatric clinics.

Re:Kids vs Adults? (0)

Anonymous Coward | more than 2 years ago | (#39061499)

In kids sinusitis is even less common than adults, if only because the sinuses are not present at birth and take years to form. Doesn't stop over-prescription of antibiotics for "sinusitis" but it is a much less common problem and your children were likely given inappropriate antibiotics.

Salt water flush (1)

elgeeko.com (2472782) | more than 2 years ago | (#39061395)

Works every time, costs pennies and has almost no side effects. Don't need a prescription for it either.

Why is this news? (1)

O('_')O_Bush (1162487) | more than 2 years ago | (#39061397)

Anyone who has been to the doctor for a sinus infection has been told that they are rarely bacterial in origin, and are almost exclusively viral.

They give antibiotics as a precaution and as a placebo, as patients feel better taking *something*, regardless whether it is effective.

Antibiotics for sinus infection? (1)

Hentes (2461350) | more than 2 years ago | (#39061515)

Even if they can cure it, aren't antibiotics reserved for serious illnesses that can't be cured by other means? You can cure a cold dozens of other ways without breeding a new strain of resistent bacteria, what the hell is wrong with you Americans?

PSA: use saline nasal spray and salt water gargle (1)

Anonymous Coward | more than 2 years ago | (#39061549)

If you feel any sinus pressure or notice any drainage, gargle with warm salt water, and use saline nasal spray.
If the pressure is acute, take a nasal decongestant.

If you do the above early enough, you will stop getting sinus infections.

p.s. PRO-TIP: You can refill nasal spray bottles with filtered water and table salt.

not surprising (0)

Anonymous Coward | more than 2 years ago | (#39061569)

Cause the typical cause of sinus infections are either viral (think cold sores in your sinus) or allergy (think parasites and fungus)... Bacterial infections still exist, but I think hygiene has gotten better over the years...

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