Antibiotics for acute rhinosinusitis in adults

Abstract

Background Acute rhinosinusitis is an acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of acute rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. We merged two Cochrane Reviews for this update, which comprised di erent approaches with overlapping populations, resulting in di erent conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. Objectives To assess the e ects of antibiotics versus placebo or no treatment in adults with acute rhinosinusitis in ambulatory care settings.

Accuracy of Signs and Symptoms for the Diagnosis of Acute Rhinosinusitis and Acute Bacterial Rhinosinusitis

“…Trials using imaging (3 radiography, 1 CT) found a larger benefit, suggesting some validity for the concept of imaging as a reference standard. 6 To date no randomized trials of antibiotics or other interventions have enrolled patients with ABRS diagnosed by inspection of fluid.…”

“…A systematic review found a 5% absolute increase in the rate of cure with antibiotics for clinically diagnosed ARS, compared with an 11% increase in rate of cure with imaging-diagnosed ARS; more accurate clinical diagnosis could identify the patients most likely to benefit from antibiotics. 6 Previ-ous systematic reviews of the clinical diagnosis of ARS are all more than 15 years old and did not use modern analytic techniques such as bivariate meta-analysis. [7][8][9][10] The goal of the current study is therefore to perform a comprehensive meta-analysis of the clinical diagnosis of ARS and ABRS.…”

Acute rhinosinusitis: When to prescribe an antibiotic

“…27 Antibiotic treatment is associated with a shorter duration of symptoms (NNT = 19) but an increased risk of adverse events (NNH = 8). 7,19 Amoxicillin with or without clavulanate for 5 to 10 days is first-line antibiotic therapy for most adults with ABRS. 1,3,5,8,9,11 Per AAO-HNS, the "justification for amoxicillin as first-line treatment relates to its safety, efficacy, low cost, and narrow microbiologic spectrum."…”

“…1,2,4,6 Nearly half of all patients will improve within 1 week and two-thirds of patients will improve within 2 weeks without the use of antibiotics. 7 In children, only about 6% to 7% presenting with upper respiratory symptoms meet the criteria for acute bacterial rhinosinusitis (ABRS), 8 which we'll detail in a bit. For most patients, treatment should consist of symptom management.…”

Efficacy and Safety of The Herbal Combination Containing Tropaeoli Majoris Herba and Armoraciae Rusticanae Radix in Patients Suffering from Uncomplicated, Acute Rhinosinusitis: A Randomized, Double-Blind, Placebo Controlled, Two-Arm, Parallel Group, Phase

“…R hinosinusitis (RS) is defined as simultaneous inflammation of the nasal mucous membrane ("rhinitis") and inflammation of the mucous membrane of the paranasal sinuses ("sinusitis"), which leads to symptoms like nasal blockage, obstruction or congestion or nasal discharge (anterior, posterior, nasal drip). Additional symptoms include facial pain or pressure, the reduction or loss of smell, headache and fever (1,2).…”