Antibiotics have a small treatment effect in acute sinusitis

Clinical question: 
How effective are antibiotics in treating acute sinusitis?
Bottom line: 
In a primary care setting, antibiotics have a small treatment effect in patients with uncomplicated acute sinusitis with symptoms for more than 7 days (average improvement rate of 90% in antibiotic groups and 80% in the control groups; NNT* 10).The review contains trials of treatment for clinically diagnosed acute sinusitis, whether or not confirmed by radiography or bacterial culture. Drug therapies reviewed were antibiotic versus control or comparisons between different antibiotic classes. None of the antibiotic preparations (amoxycillin, amoxycillin-clavulanate, azithromycin, cephalosporins, faropenem, fluoroquinolones, macrolides, oxymetazoline, streptogramin and tetracyclines) was superior to each other. *NNT = number needed to treat to benefit one individual.
Caveat: 
Eighty per cent of participants treated without antibiotics improved within 2 weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual level (diarrhoea, abdominal pain, vomiting and skin rashes) and general population level (antibiotic resistance).
Context: 
Sinusitis accounts for 15–21% of all antibiotic prescriptions for adults in outpatient care. Treatment options include antibiotics, decongestants, steroid drops or sprays, mucolytics, antihistamines, or sinus puncture and lavage.
Review CD#: 
CD000243
PEARLS No: 
108
Date: 
October, 2008
Authored by: 
Brian R McAvoy