General practitioners often prescribe antibiotics for respiratory tract infections when nasal discharge is purulent. Most guidelines recommend against their use for this condition, but this advice is based on one study that showed no effect.
So researchers at the University of Auckland searched the scientific literature for trials comparing antibiotics with placebo for acute purulent rhinitis (duration less than 10 days). They identified seven trials. Pooling the results showed that antibiotics for acute purulent rhinitis (a runny nose with colored discharge) may be beneficial. However, the results show that, at best, six patients get no benefit for every one who gets benefit.
Antibiotics are probably effective for acute purulent rhinitis, the authors conclude, and they can cause harm, but most patients will get better without antibiotics.
Although these findings differ from the guidelines in terms of the effectiveness of antibiotics for acute purulent rhinitis, the authors support the current “no antibiotic as first line” advice and suggest that antibiotics should be used only when symptoms have persisted for long enough to concern patients or parents.