title: Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefit. Intranasal corticosteroids might relieve symptoms; however, evidence for this benefit is currently unclear. We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis.
  
  
  METHODS
  We searched MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and Centre for Reviews and Dissemination databases until February 2011 for studies comparing intranasal corticosteroids with placebo in children or adults having clinical symptoms and signs of acute sinusitis or rhinosinusitis in ambulatory settings. We excluded chronic/allergic sinusitis. Two authors independently extracted data and assessed the studies' methodologic quality.
  
  
  RESULTS
  We included 6 studies having a total of 2,495 patients. In 5 studies, antibiotics were prescribed in addition to corticosteroids or placebo. Intranasal corticosteroids resulted in a significant, small increase in resolution of or improvement in symptoms at days 14 to 21 (risk difference [RD] = 0.08; 95% CI, 0.03-0.13). Analysis of individual symptom scores revealed most consistently significant benefits for facial pain and congestion. Subgroup analysis by time of reported outcomes showed a significant beneficial effect at 21 days (RD = 0.11; 95% CI, 0.06-0.17), but not at 14 to 15 days (RD = 0.05; 95% CI, -0.01 to 0.11). Meta-regression analysis of trials using different doses of mometasone furoate showed a significant dose-response relationship (P=.02).
  
  
  CONCLUSIONS
  Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration. Further trials are needed in antibiotic-naïve patients.
authors.affiliation: Department of Primary Care Health Sciences, Oxford University, Oxford, England, UK. gail.hayward@phc.ox.ac.uk
authors.forename: Gail
authors.initials: G
authors.lastname: Hayward
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D006801:Humans; D012044:Regression Analysis; D012852:Sinusitis / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents