NEW YORK, March 07 (Reuters) -- If you've got a sore throat or sinus inflammation, your doctor might prescribe antibiotics. However, two new studies suggest that a sugar pill might be almost as good -- taking bacteria-killing drugs for some common upper respiratory symptoms is essentially as effective as taking a placebo. However, antibiotics may be necessary for people who are very ill, the authors noted.
"In the USA, sinusitis is one of the most commonly seen complaints: almost 16 million visits to primary health care physicians in 1989 were for sinusitis," reported lead study author Dr. F. van Buchem in the current issue of The Lancet. "Given that this is such a large group of patients, avoidance of antibiotics and radiography (x-ray of the sinuses) may reduce antibiotic resistance and side-effects, and save money," wrote van Buchem, of St. Elisabeth Hospital in Tilburg, Netherlands.
Overuse of antibiotics is a serious problem, leading to strains of bacteria that are resistant to the drugs. Millions of dollars are spent every year trying to develop new medicines that stay one step ahead of infectious organisms, but in some cases only a single antibiotic remains that can kill some strains of bacteria.
Van Buchem and colleagues looked at 214 patients with sinusitis, a cluster of symptoms including face pain, nasal obstruction, and discharge. Half were given amoxicillin, an antibiotic, and half were given an inactive drug, or placebo. After two weeks, 83% of those taking the antibiotic felt better and had fewer symptoms, as did essentially the same number of those taking a placebo -- 77%.
However, there may be patients with more severe symptoms who benefit from antibiotic treatment, noted the authors.
"It is possible that the relatively small number of patients, who after two to three weeks show no improvement, would benefit from antibiotic therapy," they concluded. "This question needs further study."
In the second report, published in the British Medical Journal, 716 people, aged 4 and older, with sore throats were split into three groups -- some were given antibiotics, some no treatment at all, and the rest were given antibiotics if the symptoms persisted for more than three days.
About a third of patients in all the groups reported feeling better by the third day, and the duration of illness, the number of days off work or school, and the number of patients who were satisfied with their treatment was essentially the same.
However, those given antibiotics had fever for only one day, compared to two days for the other two groups.
"Patients prescribed antibiotics, initially, were more likely to think antibiotics were effective and to intend coming back in the future," wrote lead study author Dr. Paul Little, of Southampton University, U.K. Overall, about 60% of patients visited the doctor to "legitimize" the illness while missing work or school, and 37% went to the doctor to show family and friends that they really were sick.
"Therefore, unless patients with sore throat are very ill, doctors should consider exploring patients' concerns and avoid prescribing antibiotics -- or offer antibiotics if symptoms persist for a few days," Little wrote. Of the patients in the group that waited before taking an antibiotic, nearly 70% never did need to take the medication.
SOURCE: The Lancet (1997;349:683-687); British Medical Journal (1997;314:1-6)
