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Antibiotics for acute maxillary sinusitis.

Anneli Ahovuo-Saloranta¹, Oleg V Borisenko, Niina Kovanen

¹Finnish Office for Health Technology Assessment / FinOHTA, National Research and Development Centre for Welfare & Health / STAKES, Finn-Medi 3, Biokatu 10, Tampere, Finland, 33520.

The Cochrane Database of Systematic Reviews

|April 22, 2008

Summary

Antibiotics offer a small benefit for acute sinusitis, but most patients improve without them. Clinicians should balance this slight advantage against potential side effects.

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Area of Science:

Evidence-based medicine
Clinical pharmacology
Infectious disease

Background:

Acute sinusitis is a common diagnosis in ambulatory care, with varied expert opinions on antibiotic use.
The efficacy of antibiotics for sinusitis remains a subject of debate.

Purpose of the Study:

To evaluate the effectiveness of antibiotics in treating acute sinusitis.
To determine which antibiotic classes demonstrate the greatest efficacy.

Main Methods:

Systematic review and meta-analysis of randomized controlled trials (RCTs).
Searched Cochrane CENTRAL, MEDLINE, and EMBASE databases.
Included RCTs comparing antibiotics to placebo or different antibiotic classes for acute maxillary sinusitis.

Main Results:

Antibiotics showed a slight statistical advantage over placebo for acute sinusitis (RR 0.66, 95% CI 0.44 to 0.98).
Clinical significance is equivocal, with high spontaneous cure rates (80% placebo vs. 90% antibiotics).
No single antibiotic class was found to be superior to others.

Conclusions:

Antibiotics provide a small treatment effect for uncomplicated acute sinusitis in primary care.
A significant majority (80%) of patients improve within two weeks without antibiotics.
Weighing small benefits against potential adverse effects is crucial for clinical decision-making.