More Data on Antibiotics for Sinusitis

As the debate rages on over when to prescribe antibiotics for sinus symptoms, some of the biggest manufacturers of these common drugs are pushing back. The pharmaceutical industry has a vested interest in selling more of their patented drugs, of course, which means they are often involved in lobbying efforts aimed at every level of regulatory oversight, covering livestock as well as for humans.

At issue is the question of antibiotic resistance, the phenomenon wherein more exposure to antibiotics creates more opportunities for pathogens to evolve ways to beat them. This is basic evolutionary theory: any survival pressure on an organism favors those with genetic mutations that make the organism harder to kill. As non-mutated organisms die out, this adaptive resistance spreads through the population.

More use of antibiotics means more more opportunity for pathogens to change their form and function, evading our killer medications. Scientists used to believe this was a far-off, remote possibility, but the last two decades have seen a dramatic uptick in the incidence of broadly resistant bacteria known as superbugs, lending increased urgency to the fight against antibiotic resistance.

Today doctors are urged to be more conservative with antibiotics. Whereas before many of us would write a script just to allay the concerns of a worried patient, today stricter criteria must be met before you can get your Z-Pak from the drugstore. The initiative is making some headway: antibiotic scripts have been dropping, especially in my field of ENT medicine, which is one of the worst culprits.

But Big Pharma isn’t staying silent. Studies such as this one are being rapidly mounted and released, showing dramatic improvements in patient outcomes from slightly altered versions of common antibiotics. Consider this extraordinary result:

Altogether 9036 patients were treated with moxifloxacin, of whom 2405 adult men and women had sinusitis. Sinusitis symptoms were improved or cured in at least 92% of patients. Moxifloxacin produced significant improvements after only 3 days (71.6% of patients); 96.2% of patients were improved after 5 days. Most patients (89.5%) had recovered by day 8 and 97.3% by day 10. Physicians rated moxifloxacin therapy as ‘good’ or ‘very good’ in 96.6% of patients and almost all favoured prescribing moxifloxacin in the future. Very few adverse events were reported with moxifloxacin (<0.4%), and were mostly gastrointestinal disturbances.

Sounds pretty compelling. But consider this description of the study: “This was an open-label, prospective, uncontrolled, post-marketing surveillance study undertaken between October 2001 and June 2002.” In other words, there was no control group – the patients described were never compared with other patients who took no such drug, and the results were self-reported. Experience tells us that the vast majority of patients with these symptoms would have improved no matter what.

The only way to be sure whether you need antibiotics is to speak with an experienced sinus doctor and weigh the risks and rewards of each option. Contact the Los Angeles Sinus Institute today to talk to an expert on sinus treatment in LA.