Further Debate on Antibiotics and Sinus Infection

You may have just finished reading my prior post about the dangers of unchecked sinus infection. Today I want to discuss an ongoing debate within the otolaryngological (ENT) community about when and how early antibiotics should be prescribed for cases which are far less severe.

Why the debate? There are few really good, controlled, randomized, double-blind studies that offer definitive answers about when and why antibiotics should be recommended over rest and patience. The truth about human clinical trials is that no two patients are the same, making even the best-designed study subject to the whims of personal history and the chaotic whims of chance.

Presented with a sample patient known as Mr. X, two leading ENTs recently offered recommendations for treatment based on the (fictional) information provided. Dr. Diane Brockmeyer, one of the two physicians quoted in the study, looked at the evidence and stated that she would begin a course of antibiotics:

In the review, Brockmeyer found that Mr. X presented signs and symptoms that suggested bacterial sinusitis, including mucopurulent nasal drainage, worsening after 10 days of mild symptoms, unilateral maxillary pain, fever, and unilateral sinus tenderness. Because of an allergy to penicillin, she recommended treatment with doxycycline, 100 mg, orally twice a day for 5 to 7 days.

Dr. Howard Gold disagreed,:

He noted that he would consider antibiotics in the future depending on Mr. X’s clinical course, particularly in case of escalation of fever, facial pain or swelling, or lack of improvement with other more conservative methods.

What is going on here? The basic question is whether conservative care is just as effective as more aggressive care, but it’s a question which can become complicated when you factor in ineffable concerns like the wishes of the patient and the well-documented placebo effect. Ultimately the question of when to prescribe is impossible to pin down given current data, which is why we are currently saddled with a patchwork set of recommendations for sinusitis.

The best course of action for ENTs such as myself is to read the literature, absorb different viewpoints, and then exercise some of the medical judgment we have earned over (in my case) twenty years of medical study. No two patents are alike, and issues such as medical history, emotional state, anatomy, and even workload can all play a part in the decision to go with antibiotics or not. This is, ultimately, a choice that rests with just two people: the patient and her doctor.

To begin your conversation today, please contact the Los Angeles Sinus Institute. We can help you navigate your treatment options with care.