Spring surf and sinus infections


Spring time almost felt like spring time Saturday, minus the wind and cold water.  The ocean water felt like full-on winter Saturday as I surfed a few waves in the wind storm.  The water temp was 39 due to the "upwelling" effects that western, offshore winds have in early spring in our parts, namely the Atlantic Ocean.  The warmer surface water is blown out to sea, as cold water cycles in to fill it's place, the water in the surfzone drops in temperature.   Dropping into a wave on my 10' Tudor Classic pin felt like 2 or 3 firefighters trying to put out a fire on my face, with ice cold water.  Nevertheless, it was still fun to make some turns and enjoy the ocean after a long, hamstring influenced layoff. 

Another Springtime phenomena, is sinus congestion and infections, sometimes allergy related.  In February of 2012, The Washington University School of Medicine in St. Louis, Missouri released an important study of antibiotics and acute sinus infections, and was published in JAMA that same month.  The purpose was to give namely primary care physicians the evidence needed to tell patients they will get better on their own, and to not take antibiotics.  The researchers saw no difference between the patients given Amoxicillin and the placebo.  Hence, they concluded antibiotics are unneeded for symptoms to resolve in 10 days.  As well as they intended, 


I have the following comments on this study:

1.  Amoxicillin is not the drug of choice for sinus infections.  Streptococcus aureus, one of the bacteria involved in a bacterial rhinosinusitis produces Beta-Lactamase which renders drugs like Amoxicillin inactive.   Yep, you read it correctly,  Inactive.  However, when combined with clauvonic acid (Augmentin), the amoxicillin can fight the infection.  The clauvonic acid acts like a "suicide molecule" and inactivates the Beta-Lactamase, allowing the Amoxicillin to fight the infection by killing the bacteria, even resistant-bacteria.   

2.  Hence, Amoxicillin and placebo comparisons are useless because neither will fight the bacteria causing the infection.


Lets compare something useful to determine evidence for clinician direction.  Lets compare the symptoms of one group of patients' breathing in steam (boiling salt water) versus another group of patients taking antibiotics that would help symptoms, such as augmentin. 

My bet is breathing steam would be better for the patient and safer when factoring in the 6-7% of patients that will have an adverse reaction (Alanis. A, and Weinstein AJ. 1983)  Nasal sprays such as Oxymetazoline (over-the-counter spray Affrin) are effective but should never be used more than 3 days.  More than 3 days can cause rebound congestion rendering the medication inactive and symptoms to worsen.

Take home points: amoxicillin is useless for sinus infections and needs to be combined with clauvonic acid (augmentin).  Try breathing in steam, using a netti pot, and getting to the root of the infection cause (deviated septum, clogged ostium, infected tooth) prior to reaching for that antibiotic. Keep wishing on Spring conditions.