Article on Effectiveness of Antibiotics for Sinusitis

October 21, 2003

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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