JAMA 12/5/07 – House of God Law #13: “The delivery of good medical care is to do as much nothing as possible.” The last time we saw this rule at work was with otitis media.
A study in JAMA by Williamson et al. sought to see just what good comes from the common practice of prescribing antibiotics and nasal steroids for acute bacterial sinusitis. The study included 240 patients seen by family practitioners in the UK. To be included, the patients had to have 2 or more of the classic clinical diagnostic criteria. No radiology or lab studies were used in diagnosis.
Treatment groups were randomized to receive either antibiotics and nasal steroids, a placebo of one plus the other, or a placebo of both. Patients kept symptom diaries to track outcome.
The findings showed that symptom severity scores were similar for all groups on each of the 10 days following initiation of treatment. In short – symptoms improved by day 10, and at the same rate, regardless of whether the patient received antibiotics and/or steroids vs placebo. The hard part is now to convince patients that they dont need either.
Interestingly – the study does mention the Cochrane review on this subject which DID find a treatment effect for both antibiotics and steroids. However, they point out that the studies included in the review used radiographic evidence as diagnostic criteria – which does not commonly happen in the community. (And the utility of which is whole other bag of worms that will have to be covered another day)