Letters

Antibiotics for acute rhinitis: effective?

From BMJ USA 2003;Feb:58

RAPID RESPONSES FROM BMJ.COM Following is an edited excerpt from one of the Rapid Responses generated by this editorial, which can be read in their entirety at http://bmj.com/cgi/eletters/325/7376/1311.Editor

Antibiotics for acute rhinitis: effective?

EDITORIn this editorial, our study is correctly cited as one of the trials showing a benefit from antibiotics on the duration of purulent rhinorrhea. In our study at least half of the participants suffered from rhinosinusitis (confirmed by radiology), not just rhinitis. Besides the duration of purulent rhinorrhea, we also reported the duration of general illness and facial pain, and we compared the severity change for 23 different symptoms such as quality of sleep, fatigue, concentration, time off from work or school, etc. Yet, for none of these outcomes did we find a significant benefit from amoxicillinnot even the need to blow the nose was significantly decreased. The only effect was that the mucus became non-purulent sooner in the amoxicillin-treated group. We therefore concluded that antibiotics are not effective.

In trials or meta-analyses concerning self-limiting diseases, patient-centered end points (eg, impairment of well-being) should be considered as measures of effectiveness. Upper respiratory tract infections make people feel ill. An effect on this feeling of illness is more important for the patient than the color of the rhinorrhea. At the moment, however, there is no evidence that antibiotics have an effect on "feeling ill." Antibiotics may be effective to change the color of purulent rhinorrhea but not to cure purulent rhinitis.

An I De Sutter, researcher. 
An.desutter{at}rug.ac.be

Marc De Meyere. 
Mieke van Driel. 
Thierry Christiaens. 
Jan De Maeseneer. 
Department of General Practice and Primary Health Care, Gent, Belgium