No antibiotics for uncomplicated rhinosinusitis

BMJ 2012;345:e6926

Research News

No antibiotics for uncomplicated rhinosinusitis

Cochrane Database Syst Rev 2012;10:CD006089
[Link to Cochrane review article abstract]

Adults with symptoms of sinusitis get better slightly faster when given antibiotics, but the difference isn €™t big enough to justify routine treatment, according to a new review. Pooled analyses from 10 placebo controlled trials suggest that antibiotics speed the recovery of one adult for every 18 treated (number needed to treat 18, 95% CI 10 to 115). Conversely, doctors need to treat only 8 (6 to 13) to cause one extra adverse event, most commonly nausea, vomiting, abdominal pain, or diarrhoea. That unfavourable trade off, coupled with the well known threat of antibiotic resistance, means antibiotics aren €™t justified for unselected adults presenting to primary care, say the authors.

The 2450 participants in the review went to their doctor with a cold and symptoms such as facial pain, dental pain, postnasal drip, or purulent nasal discharge for more than a week but less than a month. They had no investigations. Almost half were better within a week, whatever treatment they had (47%). Just over 70% were better within a fortnight. Those given antibiotics such as amoxicillin took just as many analgesics as controls and used just as many nasal decongestants. The only serious complication €”a brain abscess €”occurred in an adult treated with antibiotics.

Antibiotics seemed to work better for the subgroup with purulent nasal discharge, but again the risk of side effects outweighed the benefits of treatment (11 more patients recovering faster versus 12 more with side effects for every 100 patients given antibiotics).

© 2012 BMJ Publishing Group Ltd

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