Physician’s First Watch


Antibiotic, Nasal Steroid Not Effective for Treating Acute Sinusitis

Fitness Strongly Predicts Mortality Risk in the Elderly, Regardless of Adiposity

FDA: Desmopressin Increases Risk for Hyponatremia

Antibiotic, Nasal Steroid Not Effective for Treating Acute Sinusitis

Amoxicillin or budesonide, either alone or in combination, doesn’t improve symptoms of acute sinusitis, according to a randomized, double-blind trial in JAMA.

The study included some 200 patients over age 15, from 58 family practices in the U.K., who met clinical criteria for acute sinusitis (at least two of the following: unilateral or bilateral purulent nasal discharge, unilateral pain, and intranasal pus). The patients were assigned to receive the antibiotic amoxicillin, the topical nasal steroid budesonide, both, or placebos. Patients with recurrent sinusitis were excluded.

The proportion of patients with symptoms lasting 10 days or more did not differ among the four groups. Overall, 40% of patients were cured at 1 week, with no differences among groups.

An editorialist notes that certain subgroups of patients may benefit from antibiotics or topical steroids, but until such subgroups are identified, “cautious use of antibiotics in the general practice setting for patients with sinusitis is warranted.”

JAMA article (Free)

JAMA editorial (Subscription required)

Fitness Strongly Predicts Mortality Risk in the Elderly, Regardless of Adiposity

Maintaining cardiorespiratory fitness may be at least as important as avoiding obesity in reducing mortality among the aged, researchers report in JAMA.

A cohort of some 2600 adults aged 60 or older underwent a baseline health exam and exercise testing. After a mean follow-up of 12 years, the authors write, “both fitness and BMI were strong and independent predictors of all-cause mortality,” regardless of other measures of adiposity, such as body-fat percentage. They also found that people who were fit and obese had a lower risk for all-cause death than did people who were unfit and normal weight or lean.

They conclude: “It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity, such as brisk walking for 30 minutes or more on most days of the week.”

JAMA article (Free abstract; full text requires subscription)

FDA: Desmopressin Increases Risk for Hyponatremia

The antidiuretic drug desmopressin acetate increases the risk for severe hyponatremia in some patients, the FDA said on Tuesday.

The agency has reviewed some 60 incidents of hyponatremia-related seizures linked to desmopressin. Two-thirds of the cases were in patients who had a disease or were taking drugs also associated with hyponatremia or seizures; over half were associated with the intranasal formulation.

The FDA recommends that:

  • children with primary nocturnal enuresis not be given the intranasal formulation, and that physicians “should consider other options”;
  • patients taking desmopressin tablets stop treatment during periods of fluid and electrolyte imbalance (e.g., fever, recurrent diarrhea or vomiting, intense exercise, or other conditions associated with increased water intake);
  • all formulations be used cautiously in patients “with habitual or psychogenic polydipsia or in patients who are taking drugs that may cause them to drink more fluids, such as tricyclic antidepressants and [SSRIs].”

FDA alert (Free)