Are antibiotics indicated in the treatment of acute sinusitis?
Jeffrey A. Smith, M.D.
May 2, 1997
Clinical scenario: A 35 year old white female with no significant past medical history presents with the complaint of feeling ill with purulent nasal drainage, and facial headache for the past two weeks and has maxillary sinus tenderness on exam. Are antibiotics indicated in addition to symptomatic treatment?
Clinical Bottom Line: Antibiotic treatment did not
improve the clinical course of acute
maxillary sinusitis presenting in general practice.
The Evidence: A randomized, double blind
study comparing Amoxycillin 750mg TID for
2 weeks vs. placebo in the treatment of acute sinusitis as diagnosed by symptoms and
|Greatly decreased symptoms||78 (77%)||87(83%)||26%||0.06||17|
|Cured with no symptoms||53(52%)||68(65%)||27%||0.13||8|
|Side Effects||9 (9%)||29(28%)||21%||0.19||6|
1. There was no statistically significant difference in improvement of symptoms (p=0.20), or cure with no symptoms (p=0.06) between the groups.
2. Although the return of radiographs to normal was significantly higher in the antibiotic group than the placebo group (p=.03), the radiographs of the placebo group were more abnormal initially. If the mean improvement in radiographs is compared, the results are similar. Physicians' ability to predict radiographic sinusitis was poor. If radiography had not been performed and all patients suspected of having sinusitis on clinical grounds were treated with antibiotics, the effect of antibiotic treatment would likely be even less.
4. The number of patients suffering relapses was higher (though not statistically significant) in the antibiotic group than in the placebo group (21 vs. 17%).
5. Patients treated with antibiotics are more likely to have a side-effect in comparison to placebo than they are to have an improvement or a cure in comparison to placebo.
6. Overall, acute maxillary sinusitis had a relatively benign clinical course, with 80% of all patients reporting no or few symptoms after two weeks. No patients in either group developed complications of sinusitis.
7. Other studies have shown that Amoxycillin is as good as other antibiotics in the treatment of sinusitis, so it is unlikely that trials utilizing other antibiotics would reveal significantlydifferent results.
van Buchem FL, et al. Primary care-based randornised placebo controlled trial of antibiotic treatment in acute maxillary sinusitis. Lancet 1997; 349:683-87 March 8