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Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis
S D de Ferranti1, J P Ioannidis, J Lau
1Division of Clinical Care Research, Department of Medicine, New England Medical Center, 750 Washington Street, Boston, MA 02111, USA.
Objectives:
To examine whether antibiotics are indicated in treating uncomplicated acute sinusitis and, if so, whether newer and more expensive antibiotics with broad spectra of antimicrobial activity are more effective than amoxycillin or folate inhibitors.
Design:
Meta-analysis of randomised trials.
Setting:
Outpatient clinics.
Subjects:
2717 patients with acute sinusitis or acute exacerbation of chronic sinusitis from 27 trials.
Interventions:
Any antibiotic versus placebo; amoxycillin or folate inhibitors versus newer, more expensive antibiotics.
Main Outcome Measurements:
Clinical failures and cures.
Results:
Compared with placebo, antibiotics decreased the incidence of clinical failures by half (risk ratio 0.54 (95% confidence interval 0.37 to 0.79)). Risk of clinical failure among 1553 randomised patients was not meaningfully decreased with more expensive antibiotics as compared with amoxycillin (risk ratio 0.86 (0.62 to 1.19); risk difference 0.9 fewer failures per 100 patients (1.4 more failures to 3.1 fewer failures per 100 patients)). The results were similar for other antibiotics versus folate inhibitors (risk ratio 1.01 (0.52 to 1.97)), but data were sparse (n=410) and of low quality.
Conclusions:
Amoxycillin and folate inhibitors are essentially as effective as more expensive antibiotics for the initial treatment of uncomplicated acute sinusitis. Small differences in efficacy may exist, but are unlikely to be clinically important.
Insights
For uncomplicated acute sinusitis, amoxicillin and folate inhibitors are as effective as newer, more expensive antibiotics. Antibiotics in general are more effective than placebo for treating acute sinusitis.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pharmacology
Background:
- Acute sinusitis is a common condition often treated with antibiotics.
- The efficacy of different antibiotic classes for uncomplicated acute sinusitis requires clarification.
Purpose of the Study:
- To determine if antibiotics are indicated for uncomplicated acute sinusitis.
- To compare the effectiveness of amoxicillin or folate inhibitors against newer, broad-spectrum antibiotics.
Main Methods:
- Meta-analysis of 27 randomized controlled trials involving 2717 patients.
- Comparison of antibiotics versus placebo, and amoxicillin/folate inhibitors versus newer antibiotics.
- Primary outcome measures were clinical failures and cures.
Main Results:
- Antibiotics significantly reduced clinical failures compared to placebo (RR 0.54).
- No significant difference in clinical failure rates between amoxicillin and more expensive antibiotics (RR 0.86).
- Similar findings when comparing other antibiotics to folate inhibitors, though data were limited.
Conclusions:
- Amoxicillin and folate inhibitors demonstrate comparable efficacy to more expensive antibiotics for initial treatment of uncomplicated acute sinusitis.
- Any minor efficacy differences are unlikely to be clinically significant.