Doctors Overprescribing Antibiotics for Sinus Infections

Mar 19, 09:34 PM

Current Headlines: By Julie Anderson, Omaha World-Herald, Neb.

Mar. 19--The headache, the pressure, the runny nose. It's all part of a sinus infection, and many of us head to a doctor to seek relief.

But too often, according to a new study by University of Nebraska Medical Center researchers, doctors prescribe antibiotics to treat the condition, despite the fact that about 90 percent of them are caused by viruses, which aren't vulnerable to the drugs.

In fact, the study, whose results were released Monday, found that antibiotics were prescribed for about 82 percent of acute sinus infections and for nearly 70 percent of chronic sinus infections. The study was based on data from two federal surveys of doctors between 1999 and 2002.

"Physicians are still prescribing antibiotics at a very high level for this condition," said Dr. Donald Leopold, chairman of UNMC's department of otolaryngology-head and neck surgery. The report appears in the March issue of Archives of Otolaryngology-Head and Neck Surgery.

The research findings back up longtime concerns about overuse of antibiotics for sinus infections, which can fuel antibiotic resistance.

"This is perhaps the best data we now have that this is a problem," Leopold said, and it "will give us some data from which to go forward."

The message about overprescription already is getting out to doctors at professional meetings. And it appears to be trickling down to daily practice, with some doctors recommending the use of saline rinses as an alternative.

Sinus infections -- which doctors call rhinosinusitis -- are nothing to sneeze at when it comes to health care spending or antibiotic use.

In 1992, the study found, the direct medical costs of sinus infections totaled nearly $2.4 billion. With indirect costs, the total goes much higher. Sinus infections in 2002 accounted for some one in five prescriptions for antibiotics in adults and nearly one in 10 such prescriptions for children.

There are several reasons why the practice of prescribing antibiotics persists.

Sinus infections are hard to diagnose, said report co-author Dr. David Denman, now a private practice ear, nose and throat specialist in Omaha. There's no good test to tell a viral infection from a bacterial one. The symptoms -- runny nose and congestion -- are the same.

Sinus infection is a difficult problem to treat, said Hadley Sharp, a senior medical student, who led the study. Antibiotics may alleviate inflammation that can contribute to the problem, making it appear that they worked.

Some patients with other health conditions should get antibiotics early when they start having sinus problems because they may be more vulnerable to other infections, Denman said.

For all those reasons, physicians may feel pressured to prescribe antibiotics.

An old remedy -- the saline rinse -- offers relief for many, the researchers said.

Sinus sufferers squirt a saline solution up one nostril and let it drain out the other, then repeat the process on the other side. The solution essentially cleanses the sinus, washing away mucus that can provide a home for infectious agents.

Leopold said patients typically look askance when he recommends the process. But kits now available in drugstores have made the process relatively quick, easy and inexpensive. He does not, however, recommend making the solution out of items in the kitchen.

The rinses also can help relieve cold and allergy symptoms, he said.

Dr. Tom Casale, chief of allergy and immunology at Creighton University Medical Center, said doctors need to better explain the difference between viral and bacterial infections.

"So if we send them away without a prescription for antibiotics," said Casale, who was not involved in the study, "they have a reason why."

Dr. Robert Beer, an Omaha family medicine doctor at Alegent Health Lakeside Hills Court Clinic, said patients are beginning to catch on.

"More and more, people are not asking for antibiotics," he said. "People are becoming aware of the fact that antibiotics are not as helpful and there may be some problems with using antibiotics unnecessarily."

The report's third co-author was Susan Puumala of UNMC's preventive and societal medicine department.

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