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According to the Archives of Otolaryngology Head and Neck Surgery report, two national studies showed that Americans made more than 17 million visits to health-care facilities for sinus infections between 1999 and 2002. At least one antibiotic was prescribed in nearly 83 percent of cases of acute rhinosinusitis and in nearly 70 percent of cases of the chronic, longer-running version of the condition, in which symptoms persist for at least 12 weeks.

Doctors understand that overprescribing antibiotics can lead to a dangerous microbial resistance to the drugs. But it's hard to preach that wisdom to someone with a drippy, hurting sinus who wants immediate relief, Leopold acknowledged. Because more effective drugs are lacking, "patients are desperate, physicians are desperate, and it is not a happy situation," he said.

Consider the case of the working physician called on to treat such a patient, said Dr. Neil L. Kao, vice chairman of the rhinitis/sinusitis committee of the American College of Allergy, Asthma and Immunology. He happens to be just such a working physician, in private practice in Greenville, S.C.

There are ways to determine whether a sinus infection is bacterial, Kao said. One is to do endoscopy, running a tube into the nose to obtain a sample of mucus from the sinus. Another is nasal cytology, examining a swab from the lining of the nose. A third is to take an X-ray.

"The problem with all of these is that they are expensive and time-consuming," Kao said. "The differences between symptoms caused by an allergy, bacterial infection, viral infection and a common cold are few. For us, even specialist doctors, when you see someone with acute nasal symptoms, it
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