Most Purulent Runny Noses Will Dry Up Without Antibiotics

AUCKLAND, New Zealand, July 21 -- Let purulent runny noses run-at least up to 10 days, according to New Zealand researchers.

In a review and a meta-analysis of data from seven randomized controlled trials, they found that antibiotics seem to work for acute purulent rhinitis but apparently aren't needed for most patients. Bruce Arroll, M.D., of the University of Auckland here, and colleagues reported online in the BMJ.

Also, the drugs can cause harm, usually in the form of gastrointestinal effects, they added, and there is concern about the overuse of antibiotics leading to bacterial resistance.

In the pooled results from the seven trials, the New Zealand researchers found that although antibiotics may help, the pooled relative risk of benefit at five to eight days with antibiotics was 1.18 (95% CI, 1.05 to 1.33).

The number of patients needed to treat with antibiotics ranged from seven to 15 when the pooled relative risk was applied to the rates in the controls. This meant that, at best, six patients would get no benefit for every one patient who is helped, they said.

The relative risk for adverse events with antibiotics was 1.46 (CI, 1.10 to 1.94). The number of patients needed for adverse effects ranged from 12 to 78. Furthermore, the number of patients needed to treat for benefit overlapped with the numbers needed to cause harm, they said. No serious adverse effects were reported in the placebo arm.

Adverse effects included vomiting, diarrhea, abdominal pain, and also a small number of rashes and hyperactivity.

Various antibiotics were used in the studies. However, the relative risk from pooling two Augmentin (amoxicillin) studies was statistically significant, so that Augmentin may be preferred if any antibiotic is used, they said.

The difference between sinusitis and acute purulent rhinitis is not always clear, they said, as sinus involvement in the common cold may be the norm: 53% to 56% of the participants in one of the studies had unilateral facial pain. It is possible that antibiotics may help purulent rhinitis with or without the presence of sinusitis, Dr. Arroll said, suggesting that future studies should specifically assess the presence of sinus infection.

Summing up, the clinicians wrote that although these findings differ from the guidelines in that there may be a role for antibiotics, they advise "watchful waiting." Antibiotics should be used only when symptoms have persisted long enough to concern parents or patients, they recommend, at which point antibiotics may be considered, given that the ill effects were usually gastrointestinal.

Despite the fact that the meta-analysis results differ from the guidelines, "We support the current guidelines in their advice not to use antibiotics but arrive at this point by taking into account the evidence, the benefits, and the harms of both treating and not treating," they concluded.

Dr. Arroll wrote that he is a member of the Future Forum, an educational foundation funded by AstraZeneca UK.