Medical Paper Papers
1: Cochrane Database Syst Rev. 2003;(2):CD000243.
Antibiotics for acute maxillary sinusitis.
Update of: Cochrane Database Syst Rev. 2000;(2):CD000243.
Williams JW Jr, Aguilar C, Cornell J, Chiquette ED, Makela M, Holleman DR, Simel
DL.
Medicine, Durham Veterans Affairs Medical Center/ Duke University Medical
Center, 508 Fulton Street, HSRD (152), Durham, NC 27705, USA.
willi007@mc.duke.edu
BACKGROUND: For adults seeking care in ambulatory medical practices, sinusitis is
the most common diagnosis treated with antibiotics. OBJECTIVES: We examined whether
antibiotics are indicated for acute sinusitis, and if so, which antibiotic classes
are most effective. SEARCH StrATEGY: Relevant studies were identified from searches
of MEDLINE and EMBASE in December 2001, contacts with pharmaceutical companies and
bibliographies of included studies. SELECTION
CRITERIA: Randomized trials were eligible that compared antibiotic to control or
antibiotics from different classes, for acute maxillary sinusitis. Additional criteria
for inclusion were diagnostic confirmation by radiograph or sinus aspiration, outcomes
that included clinical cure or improvement, and a sample size of 30 or more adults.
Of 2058 potentially relevant studies, two or more reviewers identified 49 studies
meeting selection criteria.
DATA COLLECTION AND ANALYSIS: Data were extracted independently by two persons and
synthesized descriptively. Some data were analyzed quantitatively using a random
effects model. Primary outcomes were: a) clinical cure, and b) clinical cure or
improvement. Secondary outcomes were radiographic improvement, relapse rates, and
dropouts due to adverse effects. MAIN RESULTS: Forty-nine trials, involving 13,660
participants, evaluated antibiotic treatment for acute maxillary sinusitis. Major
comparisons were antibiotic versus control (n of 5); newer, non-penicillin antibiotic
versus penicillin class (n of 10); and amoxicillin-clavulanate versus other extended
spectrum antibiotics (n of 17), where n is the number of trials. Most trials were
conducted in otolaryngology settings. Only 8 trials described adequate allocation
and concealment procedures; 20 were double-blind. Compared to control, penicillin
improved clinical cures [relative risk (RR) 1.72; 95% CI 1.00 to 2.96]. Treatment
with amoxicillin did not significantly improve cure rates (RR 2.06; 95% CI 0.65
to 6.53) but there was significant variability between studies. Radiographic outcomes
were improved by antibiotic treatment. Comparisons between classes of antibiotics
showed no significant differences: newer non-penicillins versus penicillins (RR
for cure 1.07; 95% CI 0.99 to 1.17); newer non-penicillins versus amoxicillin-clavulanate
(RR for cure 1.03; 95% CI 0.96 to 1.11). Compared to amoxicillin-clavulanate, dropouts
due to adverse effects were significantly lower for cephalosporin antibiotics (RR
0.47; 95% CI 0.30 to 0.73). Relapse rates within one month of successful therapy
were 7.7%. REVIEWER`S
CONCLUSIONS: For acute maxillary sinusitis confirmed radiographically or by aspiration,
current evidence is limited but supports the use of penicillin or amoxicillin for
7 to 14 days. Clinicians should weigh the moderate benefits of antibiotic treatment
against the potential for adverse effects.
Publication Types:
PMID: 12804392 [PubMed - indexed for MEDLINE]
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