Dr. Hallberg: Rethinking amoxicillin for sinus infections

Sinus infections account for about 20 percent of antibiotic prescriptions in the United States, but a recent study published in the Journal of the American Medical Association found that a common antibiotic is no more effective in treating sinus infections than placebos.

MPR's medical analyst Dr. Jon Hallberg discussed the study's findings with Tom Crann of All Things Considered. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic.

An edited transcript of that discussion is below.

Dr. Jon Hallberg: This study is one of those gold standard studies that took people, put them into two different categories. One group got amoxicillin and the other group got a placebo pill that looked and tasted like amoxicillin. They found that after three days of treatment, the amount of time it should take for an antibiotic to make you feel better, there was no difference in the groups that had sinus infections.

Tom Crann: Talk about the sinuses physically; what are they and what do they do?

Hallberg: The sinuses are hollowed out areas in the cheekbones and in the forehead, and there are even two more sets that are kind of between the eyes. What purpose they really serve, we don't know, but when they get filled up with pus, snot basically, we all know what that feels like.

Crann: Why wouldn't the antibiotics work?

Hallberg: There are two main reasons. The first, and probably the most important, is that it's clear that a lot of sinus infections are not caused by bacteria. It's probably a virus, and we all know that antibiotics do not treat viral infections. That may be one of the biggest directions we need to look at is how do we differentiate those sinus infections that are caused by common bacteria, that will respond to antibiotics, versus those that won't.

And the second thing is that the sinus, because it's this hollowed out thing, it's hard for the antibiotics to penetrate it. If anyone has ever had an abscess, I could give a person an oral antibiotic, but it's really not going to do the trick, you have to kind of lance the boil, you have to get the pus to drain out, I think that's one of the other problems, the unique things about the sinuses.

Crann: What kind of reactions are you seeing in the clinic here from patients who don't feel good and want you to do something about it?

Hallberg: People have history, and the reality is, though, if you wait long enough, the symptoms will go away typically ... Being on antibiotics didn't make a difference in the outcome, that's the science of it, that's the study.

Crann: So what does work for sinus infections?

Hallberg: With this study, what they gave everybody, regardless of which arm of the study they were in. They got acetaminophen, or Tylenol, to reduce symptoms. They had a nasal spray that sort of hydrates the nose. They got some Sudafed, which can help things dry up. And they also got some guaifenesin, which can thin the mucus. So, all those things can, at least symptomatically, help us a bit.

Many people have heard about a neti pot, or nasal irrigation. That really hasn't been studied in a very scientific way yet, but a lot of people feel like there's some definite promise there, and studies are under way to look at how effective that can be.

Crann: What does that study tell us about antibiotic use and the trends right now?

Hallberg: This flies completely in the face of what we think we're doing. It's been recommended that we use first line simple antibiotics like amoxicillin for things like sinus infections that are very carefully diagnosed. But that's the beauty of science and the beauty of studies like this is that it's actually getting us to think of what we're doing, so it's not reflexive, so we actually step back for a moment and look at the big picture.

Interview transcribed by Jon Collins, MPR reporter.

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