title: Systemic antibiotics for chronic rhinosinusitis without nasal polyps in adults.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is a common health problem which significantly affects quality of life. A wide range of medical and surgical therapies have been used to treat CRS. Both systemic and topical antibiotics are used with the aim of eliminating infection and inflammation, altering bacterial biofilm formation, reversing ostial occlusion and improving symptoms. Various groups of systemic antibiotics have been studied; clinical cure rates reported are inconsistent and range from 50% to 95%.
  
  
  OBJECTIVE
  To determine the effectiveness and adverse reactions associated with systemic antibiotic therapy for CRS in adults.
  
  
  METHODS
  We searched the Cochrane ENT Group Trials Register; CENTRAL (2010, Issue 2); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 10 June 2010.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing systemic antibiotics with placebo for chronic rhinosinusitis in adults.
  
  
  METHODS
  Two authors extracted data independently, compared results and resolved disagreements by discussion. We assessed treatment effect by calculating the risk ratio (RR) and 95% confidence intervals (CI) of cure at a specific time point for each trial. We used mean difference (MD) and 95% CI for continuous variables (severity scores, duration of symptoms, etc.).
  
  
  RESULTS
  We included one study involving 64 patients. We assessed the overall risk of bias in this study as high. The study reported that roxithromycin could reduce the mean response score of patients by 0.73 points on a 1 to 6-point scale (95% CI 0.32 to 1.14, P = 0.0005) compared to those on placebo at three months after the start of treatment. This study also used sinonasal outcome test-20 (SNOT-20) comparing between pre and post-treatment at six, 12 and 24 weeks. The mean change in SNOT-20 from baseline at 24 weeks in the roxithromycin group was not significantly more than in the placebo group, at 0.27 points (95% CI -0.24 to 0.78, P = 0.30) on a 0 to 5-point scale.
  
  
  CONCLUSIONS
  There is limited evidence from one small study to support the use of systemic antibiotics for the curative treatment of chronic rhinosinusitis in adults. Further good quality trials, with large sample sizes, are needed to evaluate the use of antibiotics in chronic rhinosinusitis.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 40002.
authors.forename: Patorn
authors.initials: P
authors.lastname: Piromchai
authors.forename: Sanguansak
authors.initials: S
authors.lastname: Thanaviratananich
authors.forename: Malinee
authors.initials: M
authors.lastname: Laopaiboon
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D009298:Nasal Polyps; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy*; D015575:Roxithromycin / Q000627:therapeutic use*; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015575:Roxithromycin