Got Sinusitis? Hold the Antibiotics
Cochrane reviews are largely considered the gold standard for evaluating the data from across a range of different publications. With famously rigorous inclusion criteria and a careful approach to weighing results, these widely cited meta studies often upend traditional approaches in a given field.
So it is no small event that the folks at Cochrane recently published a paper that concluded the following:
Given the lack of clear benefit in terms of rapid recovery and the increase in side effects in participants treated with antibiotics, antibiotics are not recommended as first line treatment in adults with clinically diagnosed acute rhinosinusitis.
This finding jibes with where much of the field has been heading for some time: the kneejerk prescription of broad-spectrum antibiotics for severe sinus symptoms rarely helps, and may even lead to bad outcomes on the individual level (1 out of every 8 patients experienced an “adverse event”), and on the societal level (rising antibiotic resistance is a dangerous trend).
Digging into the numbers a bit, the review states that out of ten well-designed studies:
Overall, about half of all participants were cured after one week with antibiotic or placebo treatment and three-quarters were cured after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster after 7 to 14 days if they receive antibiotics instead of placebo, or 18 participants will need to be treated with antibiotics for one extra patient to be cured more quickly.
These aren’t great numbers, and the strong showing by the placebo group should give anyone pause. Now the caveat: there are some infections serious and stubborn enough that they demand antibiotics. But what the Cochrane Review has rightly pointed out is that starting with antibiotics is an unwise move. Better to wait for a definitive diagnosis from a sinusitis expert before heading to your local pharmacy.