Most sinus infections not helped by antibiotics

CHICAGO, Illinois (AP) -- Just in time for runny nose season, new research suggests routine sinus infections aren't really helped by antibiotics and other medicine that's often prescribed.

In the British study, people suffering from facial pain and a runny nose with greenish or yellowish mucus generally improved within about two weeks -- whether they took the standard antibiotic amoxicillin, steroid nose spray or fake medicine.

The results, based on patients' reporting whether their symptoms had improved, echo previous findings in children.

Antibiotics, particularly the penicillin-like drug amoxicillin, are among the most commonly prescribed medicines for sinus infections.

Steroid sprays sometimes are used, but the study found they also were no better than dummy drugs, although they appeared to provide some relief for patients with only minor symptoms.

The study should lead to a "reconsideration of antibiotic use for acute sinusitis. The current view that antibiotics are effective can now be challenged, particularly for the routine cases which physicians treat," said lead author Dr. Ian Williamson of the University of Southampton in England.

"Physicians can focus on effective remedies that improve symptom control," which include ibuprofen and other over-the-counter painkillers, Williamson said.

Inhaling steam and squirting salt water into the nose to flush out thick mucus are among other methods that sometimes provide relief, he said.

Researchers randomly assigned 240 adults to receive one of four treatments: 500 milligrams of amoxicillin three times daily for seven days and 400 units of steroid spray for 10 days; only amoxicillin; only steroid spray; or fake medicine.

Sinus infections are diagnosed in about 31 million Americans each year and are among the most common reasons for doctor visits. In the United Kingdom, primary care doctors see 50 or more cases a year, the study authors said.

The infections affect air spaces called sinuses around the nose and in the lower forehead. Inflammation and excess mucus can cause nose congestion, headaches and eye and face pain. Causes include bacteria, viruses, fungal infections and allergies.

Despite a long-held notion, recent studies have found that yellowish or greenish mucus doesn't always mean the infections are bacterial, said Dr. Vincenza Snow, a Philadelphia, Pennsylvania, internist and director of clinical programs and quality of care at the American College of Physicians.

Moreover, while antibiotics are designed to treat bacteria, these drugs aren't always very effective at treating bacterial sinus infections because the medicine has a tough time reaching the sinuses, she said.

The U.S. physicians' group issued guidelines in 2001 advising against using antibiotics for most sinus infections in otherwise healthy people, blaming overuse for contributing to the growing problem of bacteria resistant to drugs.

The group is considering updating the guidelines to say recent evidence reaffirms the drugs "don't really change the course of the illness," Snow said.

Dr. Marvin Fried, otolaryngology chairman at Montefiore Medical Center in New York, questioned whether all the patients in the study had true sinus infections. While patients were recruited by family doctors, the results were based on patients' self-reported symptoms rather than medical exams, he noted.

Still, Fried said, the conclusions are in line with September guidelines from a group of head and neck doctors, whose treatment options included observation without antibiotics for mild sinus infections

WASHINGTON, Dec. 5 — The birth rate among teenagers 15 to 19 in the United States rose 3 percent in 2006, according to a report issued Wednesday, the first such increase since 1991. The finding surprised scholars and fueled a debate about whether the Bush administration’s abstinence-only sexual education efforts are working.

The federal government spends $176 million annually on such programs. But a landmark study recently failed to demonstrate that they have any effect on delaying sexual activity among teenagers, and some studies suggest that they may actually increase pregnancy rates.

“Spending tens of million of tax dollars each year on programs that hurt our children is bad medicine and bad public policy,” said Dr. David A. Grimes, vice president of Family Health International, a nonprofit reproductive health organization based in North Carolina.

Robert Rector, a senior research fellow with the Heritage Foundation, said that blaming abstinence-only programs was “stupid.” Mr. Rector said that most young women who became pregnant were highly educated about contraceptives but wanted to have babies.

President Bush noted the long decline in teenage pregnancy rates in his 2006 State of the Union address, saying, “Wise policies such as welfare reform, drug education and support for abstinence and adoption have made a difference in the character of our country.”

In a speech last year, Senator Hillary Rodham Clinton said that rates of teenage pregnancy declined during the Clinton administration because of a focus on family planning.

Teenage birth rates are driven by rates of sex, contraception and abortion. In the 1990s, teenage sex rates dropped and condom use rose because teenagers were scared of AIDS, said Dr. John S. Santelli, chairman of the department of population and family health at Columbia University.

But recent advances in AIDS treatments have lowered concerns about the disease, and AIDS education efforts, which emphasized abstinence and condom use, have flagged.

Perhaps as a result, teenage sex rates have risen since 2001 and condom use has dropped since 2003. Abortion rates have held steady for a decade, although numbers from 2005 and 2006 are not available.

Kristin A. Moore, a senior scholar at Child Trends, a nonprofit children’s research organization, said the increase in the teenage birth rate was particularly alarming because even the 2005 rate was far higher than that in other industrialized countries.

“It’s really quite disappointing because we weren’t close to reaching our goal,” Dr. Moore said.

The lone bright spot in Wednesday’s report, issued by the Centers for Disease Control and Prevention, was that the birth rate for girls 14 and under dropped to 0.6 percent per 1,000 from 0.7 percent. Birth rates rose 3 percent among teenagers ages 15 to 17 and 4 percent among those ages 18 and 19.

The largest increase came among black teenagers, but increases were also seen among whites, Hispanics and American Indians. Birth rates among Asian teenagers continued to drop.

Unmarried childbearing reached a record high in 2006, according to the disease control centers, with unmarried mothers now accounting for 38.5 percent of all births. Births among teenagers and unmarried women tend to lead to poor outcomes for their children.

Helping to prevent these pregnancies was the reason advocates pushed for the wide availability of the morning-after pill known as Plan B. The Food and Dru Administration approved sales of Plan B without a prescription in August 2006, too late to have any effect on that year’s birth rate.

Mr. Rector of the Heritage Foundation said that teenage and unmarried birth rates were driven by the same factors: young women with little education who are devoted to mothering but see no great need to be married.

“We should be telling them that for the well-being of any child, it’s critically important that you be over the age of 20 and that you be married,” he said. “That message is not given at all.”

Dr. Santelli of Columbia said that many abstinence-only educational efforts tended to emphasize that contraceptives often fail. “They scare kids about contraception,” he said.

The report also found that the Caesarean delivery rate continued its rise, increasing 3 percent in 2006 to 31.1 percent of all births, a record. In recent years, women who have had one birth by Caesarean have often been discouraged from having subsequent births vaginally. And there is some evidence that a growing number of women are requesting Caesareans to avoid pain or vaginal stretching.

The American College of Obstetricians and Gynecologists published a position paper last month stating that some Caesareans-upon-request should be discouraged. Women who have multiple Caesarean births are more likely to suffer uterine rupture and other serious consequences.

Dr. Robert Freeman, a professor of obstetrics and gynecology at the University of California, Irvine, said that managed-care companies no longer discouraged Caesareans and malpractice fears often led doctors to opt for Caesarean at the first hint of trouble.

“These numbers are bad news,” Dr. Freeman said, “and I think it’s only going to get worse.”

For the first time since 1971, the nation’s overall fertility rate rose past the replacement rate, increasing 2 percent in 2006 to 2,101 births per 1,000 women.

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