Blog | Friday, February 17, 2012

QD: News Every Day--Amoxicillan doesn't help colds, but people use it anyway

Amoxicillin doesn't relieve symptoms of acute rhinosinusitis. Patients want it anyway. Doctors prescribe it anyway.

Stop it, according to a study that adds to the evidence that amoxicillan doesn't relieve symptoms.

Guidelines have long suggested that antibiotics offer little relief for rhinosinusitis. Physicians do it anyway, often because it's what's expected of them, authors noted.

To help settle the debate, researchers conducted a randomized, placebo-controlled trial of adults with uncomplicated disease among patients from 10 community practices in Missouri between November 2006 to May 2009. Patients were randomized to a 10-day course of either amoxicillin (n=85) (1,500 mg/d) or placebo (n=81) given in three doses per day. All patients also received treatments for pain, fever, cough, and nasal congestion to use as needed.

Symptoms were assessed using the Sinonasal Outcome Test-16 (SNOT-16; minimally important difference of 0.5 units on a 0 to 3 scale). Outcomes were assessed by phone. Results appeared in the Feb. 15 issue of the Journal of the American Medical Association.

Among the 166 adults, 92% used one or more treatments to relieve symptoms (94% for amoxicillin group vs. 90% for control group; P=.34). The mean change in SNOT-16 scores was not significantly different between groups on day 3 (decrease of 0.59 in the amoxicillin group and 0.54 in the control group; mean difference between groups of 0.03 [95% confidence interval [CI], -0.12 to 0.19]) and on day 10 (mean difference between groups of 0.01 [95% CI, -0.13 to 0.15]), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19 [95% CI, 0.024 to 0.35]).

There was no statistically significant difference in reported symptom improvement at day 3 (37% for amoxicillin group vs. 34% for the control group; P=.67) or at day 10 (78% vs. 80%, respectively; P=.71). At day 7, more patients treated with amoxicillin reported an improvement in symptoms (74% vs. 56%, respectively; P=.02).

"There is now a considerable body of evidence from clinical trials conducted in the primary care setting that antibiotics provide little if any benefit for patients with clinically diagnosed acute rhinosinusitis," the authors concluded. "Yet, antibiotic treatment for upper respiratory tract infections is often both expected by patients and prescribed by physicians."

Many patients come into a doctor's office with a clear expectation of what they want from the visit, including patients who expect antibiotics for their rhinosinusitis. Learn how to parry patient requests in this article from ACP Internist.