Sinusitis unresponsive to antibiotics or steroids

NEW YORK (Reuters Health) - Although often prescribed, the antibiotic amoxicillin and the topical steroid budesonide, either alone or in combination, are not effective treatments for sinusitis, according to a report in the Journal of the American Medical Association.

The findings are based on a study of 240 adults who developed an episode of sinusitis. The patients were randomly assigned to receive amoxicillin and a placebo nasal spray; budesonide and a placebo antibiotic; budesonide and amoxicillin or two placebos. Amoxicillin was given at a dose of 500 mg three times per day for 7 days, while budesonide was given as a 200-microgram dose in each nostril once daily for 10 days.

The proportion patients with symptoms lasting 10 days or longer was 29 percent in the two groups treated with amoxicillin, which was not significantly different from the 33.6-percent noted in the other two groups not treated with the drug, lead author Dr. Ian G. Williamson, from the University of Southampton in the UK, and colleagues report.

Similarly, patients treated with or without budesonide had about the same percentage of patients with symptoms lasting 10 days or longer -- 31.4 percent.

In a second analysis, nasal steroids appeared to be more effective in patients with relatively minor symptoms when the treatment began, the report indicates.

"Although the study by Williamson et al. has demonstrated that patients with a clinical diagnosis of sinusitis do not benefit from treatment with an antibiotic or a topical steroid, there may be subgroups that might benefit from either," Dr. Morten Lindbaek, from the University of Oslo in Norway, notes in a related editorial. Further studies are needed to address this, he adds.

SOURCE: Journal of the American Medical Association, December 5, 2007.