Most symptoms of acute sinusitis resolve just as quickly without antibiotics as they do with antibiotics, according to results of a new study published in JAMA.
Researchers from Washington University School of Medicine in Missouri, US, conducted a randomised controlled trial in which they compared quality of life improvement in patients given a 10-day course of amoxicillin vs patients given a placebo.
“Considering the public health threat posed by increasing antibiotic resistance, strong evidence of symptom relief is needed to justify prescribing of antibiotics for this usually self-limiting disease,” the authors write.
The study included 166 adult patients from 10 primary care clinics in the US.
To be included in the study patients had to have rhinosinusitis symptoms for between seven and 28 days that were neither improving nor worsening, or rhinosinusitis symptoms for seven days or fewer that first improved and then worsened.
All study participants were given a five- to seven-day supply of symptomatic treatments, unless their GP felt the treatments were contraindicated.
The treatments provided wereacetaminophen 500mg every six hours as needed for pain or fever; guaifenesin 600mg every 12 hours as needed to thin secretions; dextromethorphan hydrobromide 10mg/5mL and guaifenesin 100mg/5mL every fourto- six hours as needed for cough; pseudoephedrine-sustained action 120 mg every 12 hours as needed for nasal congestion; and 0.65 per cent saline spray, two puffs per nostril as needed.
They used the modified Sinonasal Outcome Test-16 (SNOT-16) to measure severity and frequency of 16 sinus-related symptoms over the prior few days.
Results show that the mean change in SNOT-16 scores for quality of life was similar in both groups at day three.
The mean improvement in quality-of-life scores was also similar for both groups at day 10. Symptom improvement was not significantly different between the two groups at day three or at day 10, and more patients in the amoxicillin group reported symptom improvement at day seven.
“In this study, retrospective assessment of change in sinus symptoms suggested that antibiotic treatment may provide more rapid resolution of symptoms for some patients by day seven.
However, when improvement was assessed as the difference in SNOT-16 scores, the statistically significant benefit at day seven was too small to represent any clinically important change,” the authors write.
“Evidence from this study suggests that treatment with amoxicillin for 10 days offers little clinical benefit for most patients with clinically diagnosed uncomplicated acute rhinosinusitis.”
