Takaisin Tulosta

Antimicrobial therapy for acute maxillary sinusitis

Evidence summaries
Jukkapekka Jousimaa and Helena Liira
Last reviewed as up-to-date 2.1.2019Completely updated

Level of evidence: A

The potential benefit of antibiotics to treat acute rhinosinusitis diagnosed either clinically or confirmed by imaging is marginal and needs to be seen in the context of the risk of adverse effects. Only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment.

A Cochrane review «»1 «Lemiengre MB, van Driel ML, Merenstein D et al. An...»1 included 15 trials involving 3057 participants.

Without antibiotics, 46% of participants with rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Only 5 to 11 more people per 100 were be cured faster if they received antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; 8 trials) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; 3 trials).

Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; 3 trials). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; 10 trials). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; 12 trials). A disease related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group).

References

  1. Lemiengre MB, van Driel ML, Merenstein D et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev 2018;(9):CD006089. «PMID: 30198548»PubMed