medications

Nasal Steroids Instead of Antibiotics for Treatment of Acute Rhinosinusitis?

James Thompson, MD Health Pro January 30, 2013
  • Months ago some qualified researchers (physician specialists in this case) published an article in Annals of Allergy, Asthma and Immunology which reported superior outcomes of intranasal steroid (INS) compared to antibiotic or placebo (a substance containing no medication but made to look like medication) in a clinical trial involving over nine hundred patients.


    Acute Rhinosinusitis (ARS) is typically manifested by nasal congestion, runny nose, facial pressure or pain, postnasal drip and headache. It is often caused by viruses (like the common cold virus) and lasts up to 4-12 weeks according to these researchers. Interestingly, I’ve told patients for years, that viral based sinus symptoms shouldn’t last more than one and a half to two weeks.


     

    Many healthcare professionals agree that antibiotics are grossly over prescribed for upper respiratory tract infections. Concerns about sinus infections are one of the most common reasons patients contact their doctor. Physicians are often compelled to prescribe an antibiotic when patients complain of sinus pressure, stuffy nose, yellow mucus and headache but do they really need it? Are there risks to using antibiotics when they may not be necessary?

     


    Thanks for asking!


    For years medical professionals have linked the indiscriminant use of antibiotics to the emergence of antibiotic-resistant strains of bacteria. Patients may develop deep seated sinus infections that are resistant to commonly used antibiotics after months to years repetitive antibiotic treatment. Overuse of antibiotics has also been linked to the development of fungal infections and some severe diarrheal syndromes.


    Healthcare leaders remain concerned about the unnecessary risks associated with prescribing antibiotics when not needed, as it relates to potential adverse effects of these drugs. Some examples include allergic reactions (which can be severe or fatal), stomach upset, non-allergic skin rashes, headache and many other potential side effects.



    Drug interactions are also of major concern when prescribing antibiotics. The wrong drug combinations may lead to fatal heart dysfunction or escalate the effect of other medications. If you are on a blood thinner (for example Coumadin) drug interactions which decrease its metabolism (slow the bodies elimination of it) may cause it to reach dangerously high levels. Many antibiotics decrease the effectiveness of birth control pills.



    Although antibiotics are widely used and most often well tolerated, potentials risks reviewed above, can be avoided by carefully choosing when not to use them.



    The research headed by Dr. Eli Meltzer found that patients with ARS who were treated with intranasal steroid (Mometasone, generic name of Nasonex) alone, had superior results compared to those treated only with antibiotics or placebo. They had a more rapid rate of recovery which was assessed by measuring the time from onset of treatment to minimal symptoms. Overall symptom scores were better for the INS group and were sustained to the end of the study (about one month).

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    What does this mean?

     

    Minimizing symptoms of rhinitis and promoting a more rapid recovery to normal airway function means fewer sick days from work or school. It means a better quality of life and potentially greater productivity. Even further, it means fewer return visits to the doctor and less money spent on expensive antibiotics. Perhaps it ultimately means fewer resistant bacteria strains to complicate the lives of many others.

     


    The study by Dr. Meltzer and others used Nasonex twice daily which was double the usual recommended dose for treatment. Another limb of the study actually used the standard FDA approved dose and also had better outcomes compared to placebo and antibiotic group, but not as well as the group getting the higher dose.


     

    One study doesn’t often lead to sweeping changes in patient care but I was impressed by this one. Your doctor must weigh the elements of potential effectiveness, cost and safety before deciding on how and when to prescribe medications, particularly when doses are higher than FDA approved labeling.

     


    Have you typically stopped your prescribed nasal spray for allergy treatment when you get cold symptoms?