Sept. 09--Viruses cause the vast majority of sinus infections, yet doctors often prescribe antibiotics, which only are effective against bacterial infections.
The result: Many of the 45 million or so U.S. residents who suffer from chronic sinus infections each year mistakenly think their trip to the doctor helped.
In truth, their treatment might only have contributed to antibiotic resistance in harmful bacteria and wasted health-care dollars.
A team of doctors at Ohio State University's Wexner Medical Center hopes to put a dent in the overprescribing of antibiotics.
It turns out that doctors can't quickly distinguish between sinus infections caused by viruses and the minority of infections --perhaps 10 percent or so --that are caused by bacteria.
Researchers at Wexner Medical Center are working to develop an at-home test strip that can ferret out the source of sinus infections. The team hopes patients would then discuss the results of that test with a family doctor, much as they would the results of an at-home pregnancy test.
The team has been working with local experts in the fields of protein research and microbiology to develop better ways to detect the bacteria that cause some sinus infections.
That's long been a challenge, said Dr. Subinoy Das, a sinus surgeon and researcher who's playing a key role in the Wexner Medical Center study. Problem bacteria live in slimy biological structures called biofilms that can be difficult to detect. Das compares them to the dirt piles that protect a colony of ants.
Aided by $700,000 in funding from the National Institutes of Health, researchers are working to identify proteins unique to the bacteria that cause sinus infections. They hope to enroll as many as 300 people in local clinical trials meant to fine-tune the tests so they yield fewer false positives and false negatives.
An estimated 40 percent of U.S. doctor visits in the United States are for throat, sinus or ear infections, which typically stem from a cold virus, Das said. Treatment of those infections costs more than $5 billion annually, he said.
In many cases, Das said, the symptoms of viral sinus infections can be managed with decongestants, nasal rinses and over-the-counter medications such as ibuprofen.
"This is important for health care," said Das, director of the medical center's sinus and allergy center. "If we reduce the amount of antibiotics we need to prescribe to people for simple viral infections, that would significantly reduce the amount of antibiotic resistance that we have."
Such unnecessary services added an estimated $210 billion in costs to the U.S. health-care system in 2009, the Institute of Medicine reported last week.
The Infectious Diseases Society of America this spring released its first set of guidelines for the treatment of bacterial sinus infections. In a departure from other organizations' guidelines, the society recommends that doctors use the antibiotic amoxicillin to which clavulanate has been added.Clavulanate helps overcome antibiotic resistance by inhibiting an enzyme that breaks down antibiotics.
The guidelines also urge doctors not to use other common antibiotics due to increased drug resistance in so-called super bugs.
Many of the guidelines, however, require doctors to monitor the course of an infection over several days. That delay can be costly when it comes to bacterial sinus infections.
Dr. Anthony Chow, a professor emeritus in the division of infectious diseases at the University of British Columbia, applauded the OSU effort to solve "a very difficult problem."
Chow, who led the panel that developed the society's guidelines, said many doctors practice defensive medicine and, in the absence of knowing whether a patient's sinus infection is from bacteria or a virus, prescribe antibiotics "just in case."
He questioned, however, whether testing a simple nasal swab can be effective in determining the source of an infection.
"Because the infection is coming from the sinuses, if you sample the nasal passages, you may not get a true picture of what's going on in the sinuses," he said.Das said researchers are also working to develop a medical device to ensure diagnostic swabs collect material from the right part of the nose.
"We feel confident we can develop a soft and semi-flexible swab that can be safely used at home to test your sinuses," he said.Dr. Ashish Shah, an ear, nose and throat doctor with Ohio ENT, said such a test could help reduce the 10 days or so it can take to diagnose and treat a patient.
It would likely be widely used if it proves to be cost-effective and reliable, he said.If clinical trials are successful and the Food and Drug Administration looks favorably on the test strips, they could be available in 2015, Das said.
For more information about the Infectious Diseases Society of America's guidelines, go to www.idsociety.org/2012_Rhinosinusitis_Guidelines/
bsutherly@dispatch.com
@BenSutherly
___
(c)2012 The Columbus Dispatch (Columbus, Ohio)
Visit The Columbus Dispatch (Columbus, Ohio) at www.dispatch.com
Distributed by MCT Information Services