Treatment of acute rhinosinusitis diagnosed by clinical criteria or ultrasound in primary care. A placebo-controlled randomised trial.
OBJECTIVE
To compare antibiotics and placebo in patients with clinically diagnosed acute maxillary sinusitis (AMS). To study whether sinus ultrasound examination would help to detect those patients who benefit from antibiotic therapy.


METHODS
A double-blind, randomised, placebo-controlled multicentre trial.


METHODS
Nine primary care sites in Finland.


METHODS
150 adult patients (mean age 39.7 years) with a clinical diagnosis of sinusitis.


METHODS
Antibiotics (amoxicillin 750 mg x 2, doxycycline 100 mg x 2 or penicillin V 1500 mg x 2) or placebo twice daily for 7 days; all patients were examined with sinus ultrasound after randomisation.


METHODS
Clinical success (patients' report of recovery) in telephone interview at 2 weeks.


RESULTS
A total of 146 patients completed the 2-week follow-up. Patients receiving antibiotics achieved a slightly higher rate of clinical success than patients receiving placebo (80% vs 66%; p = 0.068).


CONCLUSIONS
Antibiotics hasten symptom relief in AMS. Yet many patients recover in 2 weeks without antimicrobial treatment. Only half of patients with a clinical diagnosis of AMS have sinusitis in ultrasound examination.
Varonen
Helena
H
Department of Otorhinolaryngology, University of Helsinki, Finland. helena.varonen@duodecim.fi
Kunnamo
Ilkka
I
Savolainen
Seppo
S
Mäkelä
Marjukka
M
Revonta
Matti
M
Ruotsalainen
Jarkko
J
Malmberg
Henrik
H
D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010406:Penicillins / Q000627:therapeutic use; D010919:Placebos; D011320:Primary Health Care; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014463:Ultrasonography
D010406:Penicillins; D010919:Placebos; D000658:Amoxicillin; D004318:Doxycycline