Re: Article on Effectiveness of Antibiotics for Sinusitis

[Guest guest]

I doubt that this study was about patients with cystic

fibrosis, though! Good article, nonetheless. Thank you,

Love,

n

Article on Effectiveness of Antibiotics for Sinusitis

> Journal Watch Emergency Medicine

> September 24, 2003

> Antibiotics Are Not Effective for Sinusitis

>

> Posted 10/16/2003

>

> SummaryIn this carefully conducted, randomized, double-blind,

> placebo-controlled Swiss study, researchers evaluated the efficacy of

antibiotics for

> sinusitis diagnosed clinically in the general-practice setting. Sinus

radiographs

> were performed on all patients, but clinicians were unaware of the results

when

> they made the diagnoses. Inclusion criteria were a history of repeated

> purulent nasal discharge and sinus pain for at least 48 hours. Initially,

purulence

> on rhinoscopy also was an entry criterion, but it was dropped because few

> patients had this finding.

>

> Of 1565 eligible adult patients, 1313 (84%) were not enrolled: 441 refused

> consent (including 220 who wanted antibiotics), 439 did not meet entry

criteria,

> and 433 did not participate for other reasons. The remaining 252 patients

> received either amoxicillin (875 mg) plus clavulanate (125 mg) or placebo

twice

> daily for 6 days and were followed up at 7 and 14 days. Cure was defined

as

> zero days of interference with work or activities of daily life. No

difference in

> the cure rate was detected between the treatment and placebo groups (76.6%

> and 74.0% at 14 days). The result was the same in the subgroup of patients

who

> had pus on rhinoscopy. Diarrhea was more common in the treatment group

(odds

> ratio at 7 days, 3.89). One placebo recipient developed a brain abscess.

> Approximately 50% of patients had normal sinus radiographs.

>

> CommentAs with most minor illnesses, sinusitis goes away, even in patients

> with abnormalities detected on imaging. Explaining the natural history of

> sinusitis to patients has no side effects, does not promote resistance to

> antibiotics, and gives them what they came for -- attention.

>

> -- J. Bohan, MS, MD, FACP, FACEP

>

> SourceBucher HC et al. Effect of amoxicillin-clavulanate in clinically

> diagnosed acute rhinosinusitis: A placebo-controlled, double-blind,

randomized trial

> in general practice. Arch Intern Med 2003 Aug 11/25; 163:1793-8.

>

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[Guest guest]

The remaining 252 patients

> received either amoxicillin (875 mg) plus clavulanate (125 mg) or

placebo twice

> daily for 6 days and were followed up at 7 and 14 days.

This is a flawed study IMHO. Amxicillin to treat a sinus infection?

HA. Only Ceftin or perhaps Augmentin has been able to touch his

infection and he has to be on it for at least 14 days and more like

21 days for the antibiotic to make a difference.

To me this study shows amoxicillin for 14 days does not work for

sinusitis. I think it is a huge leap to conclude antibiotics don't

work for sinusitis at all.

jan