Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials.
BACKGROUND
In general practice, acute sinusitis is frequently diagnosed and treated with antibiotics.


OBJECTIVE
This study aimed to determine the evidence for the effectiveness of antibiotic treatment in acute maxillary sinusitis in adults by assessing the methodological quality of placebo-controlled double-blind randomized trials.


METHODS
An evaluation by four raters through a 35-item scoring-scale for internal and external validity of all placebo-controlled double-blind randomized trials on acute sinusitis found between January 1966 and July 1996.


RESULTS
Eighty-five trials were excluded because they were not placebo-controlled, double-blind, randomized, or were carried out in patients with chronic sinusitis or in children. The three remaining trials were performed in different populations (one in general practice) between 1973 and 1978. Only one study claimed superiority of antibiotic treatment. Different inclusion criteria and major outcome measures were used by the authors. The reliability of major outcome events was reported poorly or not at all and in two studies outcome measures were clinically inappropriate. The studies scored 30-62% of the maximum attainable score for internal validity and 10-20% for external validity.


CONCLUSIONS
The effectiveness of antibiotic treatment in acute maxillary sinusitis in a general practice population is not based sufficiently on evidence.
Stalman
W
W
Department of General Practice, University of Utrecht, The Netherlands.
van Essen
G A
GA
van der Graaf
Y
Y
de Melker
R A
RA
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D015523:Maxillary Sinusitis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic / Q000592:standards*
D000900:Anti-Bacterial Agents