Antibiotics for acute maxillary sinusitis

A Cochrane Systematic Review of medical research found that four out of five patients who are seen in primary care with simple sinusitis improved within two weeks even if they had not been given antibiotics.

When antibiotics were given they speeded up recovery from symptoms, but only marginally.

Having sinusitis is one of the most common reasons for visiting a doctor, with 20 million visits for this condition every year in the USA alone. It accounts for between 15 and 21 of every 100 outpatient prescriptions for antibiotics for adults. Most sinusitis accompanies viral cold infections and so can not be affected by antibiotics, but the few cases that have additional bacterial infections could benefit.

The problem is that it is not easy to distinguish people with, and without, a bacterial infection. And, amidst the growing concern that the use of antibiotics should be reduced so as to limit the increase in antibiotic resistance in bacteria, it is important to try to avoid the unnecessary use of these drugs. It is now recognised that countries with high antibiotic use have high levels of antibiotic resistance.

This systematic review drew together data from 57 separate studies that used a variety of antibiotics and designs. Six of the studies allocated a total of 747 patients to antibiotics or placebo and found that most of the patients got better within two weeks, regardless of which group they were in. The other 51 studies, with more than 15,000 patients compared different antibiotics against each, and did not identify any drug that was clearly superior to any other.

“Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects for both individuals and the general population,” says lead author Dr Anneli Ahovuo-Saloranta who works at the Finnish Office for Health Technology Assessment in Tampere, Finland.