title: Treatment of acute rhinosinusitis diagnosed by clinical criteria or ultrasound in primary care. A placebo-controlled randomised trial.
abstract: 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.
authors.affiliation: Department of Otorhinolaryngology, University of Helsinki, Finland. helena.varonen@duodecim.fi
authors.forename: Helena
authors.initials: H
authors.lastname: Varonen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kunnamo
authors.forename: Seppo
authors.initials: S
authors.lastname: Savolainen
authors.forename: Marjukka
authors.initials: M
authors.lastname: Mäkelä
authors.forename: Matti
authors.initials: M
authors.lastname: Revonta
authors.forename: Jarkko
authors.initials: J
authors.lastname: Ruotsalainen
authors.forename: Henrik
authors.initials: H
authors.lastname: Malmberg
mesh_terms: 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
chemical_list: D010406:Penicillins; D010919:Placebos; D000658:Amoxicillin; D004318:Doxycycline