Diagnosis and treatment of uncomplicated acute bacterial rhinosinusitis: summary of the Agency for Health Care Policy and Research evidence-based report.
OBJECTIVE
The goal was to critically examine evidence regarding the performance of diagnostic tests and the efficacy of antibiotic and other treatments for uncomplicated acute bacterial rhinosinusitis (ABR).


METHODS
Scientific literature was reviewed, and meta-analysis methods were used to assess diagnostic test and antibiotic efficacy. A decision analysis and cost-effective analysis were performed.


RESULTS
Although more sensitive than clinical examination for diagnosis of ABR, sinus radiograms are not cost-effective as an initial management strategy. Antibiotics reduce the incidence of clinical failures by one half compared to no treatment and, when coupled with clinical criteria-based diagnosis, present the most cost-effective treatment strategy. However, without antibiotics, symptoms in two thirds of patients improve by 14 days with no serious complications. The risk of treatment failure does not differ significantly between amoxicillin or folate inhibitors and newer, more expensive antibiotics.


CONCLUSIONS
The current literature shows that treatment of uncomplicated ABR with amoxicillin or folate inhibitors and based on clinical criteria is the most cost-effective strategy.
Benninger
M S
MS
Henry Ford Health System, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, VA, USA.
Sedory Holzer
S E
SE
Lau
J
J
D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D012220:Rhinitis / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D012852:Sinusitis / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*
D000900:Anti-Bacterial Agents; D000658:Amoxicillin