Systematic review of antimicrobial therapy in patients with acute rhinosinusitis.
OBJECTIVE
To estimate the natural history of acute rhinosinusitis and the impact of antimicrobial therapy on clinical outcomes.


METHODS
MEDLINE and Cochrane Trial Registry through February 2007 combined with manual review of retrieved article bibliographies.


METHODS
Systematic review and random-effects meta-analysis of double-blind, randomized, controlled trials comparing placebo vs oral antimicrobial for initial therapy of uncomplicated acute rhinosinusitis in patients aged 12 years or older.


RESULTS
Thirteen trials met inclusion criteria and had data suitable for pooling. Clinical cure occurred in 8% of patients who received placebo after 3 to 5 days, rising to 35% by 7 to 12 days and 45% by 14 to 15 days. Antimicrobials increased cure rates at 7 to 12 days, with an absolute rate difference of 15% (95% CI, 4%-25%). Clinical improvement occurred in 30% of patients who received placebo after 3 to 5 days, rising to 73% by 7 to 12 days and 14 to 15 days. Antimicrobials increased improvement rates at 7 to 12 days by 14% (95% CI, 1%-28%) and at 14 to 15 days by 7% (95% CI, 2%-13%). Diarrhea and adverse events were about 80% more common in patients who received antimicrobials (P < 0.03).


CONCLUSIONS
Over 70% of patients with acute rhinosinusitis are improved after 7 days, with or without antimicrobial therapy. About 7 patients must be treated to achieve one additional positive outcome at 7 to 12 days above and beyond spontaneous resolution. Generalizability of results is limited because nearly all trials involved a primary care setting and some trials excluded patients with severe illness.
Rosenfeld
Richard M
RM
Department of Otolaryngology, State University of New York Downstate Medical Center and The Long Island College Hospital, Brooklyn, NY 11201-5514, USA. richrosenfeld@msn.com
Singer
Michael
M
Jones
Stacie
S
D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D012852:Sinusitis / Q000188:drug therapy*
D000890:Anti-Infective Agents