Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review
Jakob M Burgstaller1, Johann Steurer2, David Holzmann3
1Department of Internal Medicine, Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, 8032, Zurich, Switzerland. jakob.burgstaller@usz.ch.
Abstract:
The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39-5.58)] and 7 [OR 2.29 (95 % CI 1.19-4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66-2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness.
Insights
Antibiotics effectively improve acute bacterial rhinosinusitis (ARS) symptoms within 7 days compared to placebo. However, benefits diminish by day 10, suggesting early treatment is key for antibiotic efficacy in ARS.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pharmacology
Background:
- Acute bacterial rhinosinusitis (ARS) is a common condition often treated with antibiotics.
- The optimal timing for assessing antibiotic efficacy in ARS remains a subject of investigation.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) evaluating antibiotic efficacy at various time points in patients with ARS.
- To determine the short-term and medium-term benefits of antibiotic treatment for ARS.
Main Methods:
- A systematic literature search was conducted in the Cochrane library for RCTs comparing antibiotics to placebo for ARS.
- Six RCTs were included in the synthesis, analyzing improvement rates at 3, 7, and 10 days post-treatment initiation.
Main Results:
- Antibiotic treatment showed a significant benefit over placebo for symptom improvement at 3 days (OR 2.78) and 7 days (OR 2.29).
- No significant difference in improvement rates was observed between antibiotic and placebo groups at 10 days (OR 1.36).
- Antibiotics provided a higher proportion of symptom relief within the initial days of treatment.
Conclusions:
- Antibiotic therapy is effective in accelerating symptom relief in acute bacterial rhinosinusitis within the first week of treatment.
- Assessing antibiotic efficacy solely based on long-term outcomes may not fully capture the benefits of early symptom improvement in self-limiting ARS.
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