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Antibiotics Not Warranted for Runny Noses

Study finds they're of little help and come with side effects

FRIDAY, July 21, 2006 (HealthDay News) -- Countering common practice, a new study suggests that doctors not prescribe antibiotics to help combat runny noses with colored discharge.

"Most patients will get better without antibiotics, supporting the 'no antibiotic as first line advice,'" two New Zealand researchers report in the July 22 issue of the British Medical Journal.

While antibiotics probably are effective for some cases of acute purulent rhinitis, as it is formally called, "they can cause harm, usually in the form of gastrointestinal effects," added Drs. Bruce Arroll and Timothy Kenealy, of the University of Auckland.

Their finding was based on data from seven carefully controlled trials comparing results when antibiotics were or were not given to people with severe head colds.

The great majority of patients did not benefit from antibiotic treatment. Depending on which individual trial was studied, anywhere from six to 14 people had to be given antibiotics for any one of them to benefit.

And the side effects of antibiotic therapy in those patients included vomiting, diarrhea and abdominal pain. Such side effects occurred in only one of 78 patients in one study, but one in 12 patients in another study.

"Rhinitis no, but sinusitis yes," said Dr. Robert A. Nathan, chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology.

Antibiotics can make a difference when the sinus is infected, Nathan said, adding that "I'm not even sure what rhinitis is."

Rhinitis is typically defined as an inflammation of the nose, generally due to an allergy, Nathan said. If an infection is responsible, it almost always is caused by a virus, against which antibiotics are ineffective, he said. On the other hand, sinus infections are usually caused by bacteria.

A careful diagnosis often is needed to tell the difference between rhinitis and sinusitis, Nathan said. "You need an X-ray or CT scan to confirm it," he noted.

But many doctors are not that thorough, the New Zealand researchers wrote.

"Indeed, one study found that purulent nasal discharge was a stronger predictor of antibiotic use than any other characteristic of patients," they said.

The researchers did not address the issue of overuse of antibiotics leading to growth of resistant strains of bacteria, but it is an important one, said Dr. Mark Dykewicz, professor of internal medicine at St. Louis University and a member of the academy's rhinitis/sinusitis committee.

The U.S. Food and Drug Administration in 2004 changed the labeling on antibiotics to warn doctors about the risk of resistant bacteria, Dykewicz said. The study "supports current practice guidelines that discourage use of antibiotics for purulent rhinitis of less than seven to 10 days," he said.

Dykewicz says he counsels patients who ask for antibiotic treatment of severe rhinitis that "it is likely that the infection is viral rather than bacterial, and so antibiotics are unlikely to help." He considers antibiotic treatment only if the infection lasts for perhaps two weeks, Dykewicz said.

More information

For more on rhinitis, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: Robert A. Nathan, M.D., chairman, rhinitis/sinusitis committee, American College of Allergy, Asthma and Immunology, and doctor, private practice, Colorado Springs, Col.; Mark Dykewicz, professor, internal medicine, St. Louis University; July 22, 2006, British Medical Journal
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