Health Headlines - July 23

Antibiotics Not Warranted for Runny Noses

Countering common practice, a new study suggests that doctors not prescribe antibiotics to help combat runny noses with colored discharge.

"Most patients will get better without antibiotics, supporting the 'no antibiotic as first line advice,'" two New Zealand researchers report in the July 22 issue of the British Medical Journal.

While antibiotics probably are effective for some cases of acute purulent rhinitis, as it is formally called, "they can cause harm, usually in the form of gastrointestinal effects," added Drs. Bruce Arroll and Timothy Kenealy, of the University of Auckland.

Their finding was based on data from seven carefully controlled trials comparing results when antibiotics were or were not given to people with severe head colds.

The great majority of patients did not benefit from antibiotic treatment. Depending on which individual trial was studied, anywhere from six to 14 people had to be given antibiotics for any one of them to benefit.

And the side effects of antibiotic therapy in those patients included vomiting, diarrhea and abdominal pain. Such side effects occurred in only one of 78 patients in one study, but one in 12 patients in another study.

"Rhinitis no, but sinusitis yes," said Dr. Robert A. Nathan, chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology.

Antibiotics can make a difference when the sinus is infected, Nathan said, adding that "I'm not even sure what rhinitis is."

Rhinitis is typically defined as an inflammation of the nose, generally due to an allergy, Nathan said. If an infection is responsible, it almost always is caused by a virus, against which antibiotics are ineffective, he said. On the other hand, sinus infections are usually caused by bacteria.

A careful diagnosis often is needed to tell the difference between rhinitis and sinusitis, Nathan said. "You need an X-ray or CT scan to confirm it," he noted.

But many doctors are not that thorough, the New Zealand researchers wrote.

"Indeed, one study found that purulent nasal discharge was a stronger predictor of antibiotic use than any other characteristic of patients," they said.

The researchers did not address the issue of overuse of antibiotics leading to growth of resistant strains of bacteria, but it is an important one, said Dr. Mark Dykewicz, professor of internal medicine at St. Louis University and a member of the academy's rhinitis/sinusitis committee.

The U.S. Food and Drug Administration in 2004 changed the labeling on antibiotics to warn doctors about the risk of resistant bacteria, Dykewicz said. The study "supports current practice guidelines that discourage use of antibiotics for purulent rhinitis of less than seven to 10 days," he said.

Dykewicz says he counsels patients who ask for antibiotic treatment of severe rhinitis that "it is likely that the infection is viral rather than bacterial, and so antibiotics are unlikely to help." He considers antibiotic treatment only if the infection lasts for perhaps two weeks, Dykewicz said.

High-Sugar, Low-Caffeine 'Energy' Drinks Don't Work

People who think sugary drinks are a pick-me-up may be in for a letdown: New research finds sweetened beverages actually boost sleepiness.

"People wishing to alleviate sleepiness through the consumption of a high-sugar, low-caffeine content energy drink -- erroneously believing the 'sugar rush' to be effective -- should avoid drinks that have little or no caffeine," said study co-author Clare Anderson, from the Sleep Research Centre at Loughborough University in the United Kingdom. "It is caffeine that is particularly effective for alleviating sleepiness, not sugar," she added.

Anderson and her colleague Jim Horne found that, one hour after drinking a high-sugar, low-caffeine drink, people had slower reaction times and experienced more lapses in concentration than if they had consumed a caffeine- and sugar-free beverage.

They reported the findings in the July online edition of Human Psychopharmacology: Clinical and Experimental.

As Anderson explained, "Many soft drinks contain large amounts of sugar, and previous findings had indicated that such large amounts may improve cognitive performance. However, these effects were almost immediate."

The real question, for Anderson, was whether that quick boost had any longer-term effect beyond the first 15 minutes after the so-called sugar rush disappeared.

To help answer that, she and Horne had 10 healthy adults restrict their sleep to just five hours on the day prior to the trial. Then, 60 minutes after eating a light lunch, these healthy adults were given either a high-sugar, low-caffeine energy drink (42 grams of sugar plus 30 milligrams caffeine) or an identically tasting zero-sugar drink used as a placebo. Forty-two grams of sugar is equal to about 8 teaspoons, Anderson said.

The participants were next asked to complete a 90-minute test during the afternoon low-energy period. The test assessed their level of sleepiness and ability to concentrate.

"Around 70 minutes after consumption, there was a worsening of sleepiness --delayed reaction time, increased lapses in attention -- following the consumption of a high-sugar drink, in comparison to a placebo," Anderson said.

Her conclusion: Highly-sugared drinks without caffeine do not counteract sleepiness beyond perhaps a short sugar rush. In fact, they appear to boost drowsiness.

"These drinks are of little benefit to sleepy people," Anderson said. "Caffeinated drinks, even sugary ones, are much better for counteracting detrimental effects of sleepiness."

One nutrition expert agreed that sugar won't help push energy levels past the initial minutes-long sugar rush, and even caffeine won't help you stay awake beyond a few hours.

"Energy drinks are a misnomer," said Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas and spokeswoman for the American Dietetic Association. "Sure, they provide energy in the form of calories, usually from some form of a simple sugar," she added.

Sandon explained that simple sugars are digested, absorbed and metabolized very quickly, so the energy they contain doesn't last long. "Some energy drinks may have just enough caffeine to stimulate your central nervous system and give you a false sense of feeling energized for a short period of time," Sandon said. "Keep in mind, a dose of caffeine large enough to have an energizing effect -- about 1 regular soda or cup of coffee -- will only last about 3 hours."

According to the Texas expert, there is a more lasting and healthy means of staying fresh: good sleep and a healthful diet.

"To improve a feeling of having energy, start by getting plenty of rest, fluids, and fuel your body with quality nutrients from fresh fruits, vegetables, whole grains and lean protein sources," Sandon said. "A balanced diet, including carbohydrate, fat, and protein, will keep you feeling satisfied longer."