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Steroid sprays cut sinus infection symptoms slightly

NEW YORK (Reuters Health) – Nasal spray steroids, taken for three weeks, help shorten the duration of pain and congestion from sinus infections, a new meta-analysis confirms.

“But the effect is not huge. It’s about the same as giving them an antibiotic,” said Dr. Matthew Thompson, the senior author of the study and a researcher in the department of Primary Care Health Sciences at the University of Oxford in England.

Antibiotics themselves are not extremely helpful — and most people who take them will see no benefit (see Reuters Health story of Feb. 15, 2012). But for patients or doctors seeking a way to speed up the course of an illness, nasal spray steroids might offer an alternative to antibiotics, Dr. Thompson told Reuters Health.

His team gathered data from six different studies that compared steroid sprays to placebo, in nearly 2,500 people. The steroids included budesonide (Rhonicort Aqua), fluticasone propionate (Flonase), and mometasone furoate (Nasonex).

Two thirds of people felt better within two to three weeks, without having taken a steroid spray. Among the people who did take a steroid, an additional 10% felt better by three weeks, the researchers said.

In other words, ten people would have to be treated with steroids for three weeks for one of them to feel some relief from their symptoms.

“And who knows if you’re the one?” said Dr. John Hickner, a professor at Case Western Reserve School of Medicine, who was not involved in the study.

Dr. Hickner pointed out that the reduction in symptoms was quite small — on the order of 7% to 8% less severe congestion or pain among people who took the steroids.

He said the benefits of nasal steroids seem small compared to the cost.

In an editorial accompanying the study in the May issue of Annals of Family Medicine, Dr. Hickner wrote that nasal spray steroids can cost more than $60 — far more expensive than antibiotics or over the counter pain and sinus medications.

“I might pay ten cents for ibuprofen. I don’t think I’d pay 62 bucks (for steroids) to get better a day sooner,” Dr. Hickner told Reuters Health.

In the U.K., steroid sprays are much less expensive and are available over the counter.

Dr. Thompson said that if doctors want something to offer and patients want something to take, nasal steroids could steer them away from antibiotics.

The most common side effects of nasal sprays in the studies were bloody nose and headache.

“One could argue, why not try nasal steroids anther than antibiotics? To me it gives clinicians and patients another option…and perhaps might help them to use less antibiotics,” said Dr. Thompson.

SOURCE: http://bit.ly/JgQ89t

Ann Fam Med 2012.