Commonly prescribed antibiotics, topical steroids or even their combination, is not really effective in the treatment of acute sinusitis, according to a study by researcher Ian G. Williamson and colleagues from the University of Southampton, Southampton, England, published in the December 2007 issue of the Journal of American Medical Association.

The study was a double-blind, randomized, placebo-controlled trial involving 240 adult patients in 58 family practice centers and was conducted over a period of 4 years between November 2001 and November 2005. The participants were chosen on the basis of the presence of at least 2 factors from the diagnostic criteria for acute nonrecurrent sinusitis (local pain with unilateral predominance, purulent rhinorrhea with unilateral predominance, purulent rhinorrhea bilateral, and presence of pus in the nasal cavity). The patients were then randomized into 4 groups: antibiotic and nasal steroid; placebo antibiotic and nasal steroid; antibiotic and placebo nasal steroid; placebo antibiotic and placebo nasal steroid. The antibiotic used in the study was amoxicillin (500 mg 3 times a day for one week) and the steroid used was budesonide (200 microgram in each nostril for 10 days).

Almost 29% of the subjects on amoxicillin had symptoms beyond 10 days, compared to 33.6% subjects in whom antibiotic therapy was withheld (adjusted odds ratio, 0.99). Similarly, 31.4% patients on budesonide were symptomatic at the end of 10 days compared to the same proportion of subjects who were not given the steroid (adjusted odds ratio, 0.93). The authors concluded that neither the antibiotic nor the steroid influenced symptomatic recovery.

A similar study by Bucher HC et al (Archives of Internal Medicine, 2003) supported the lack of efficacy of conventional treatment in sinusitis, and a study by Stalman W et al (British Journal of General Practice, 1997) did not identify any definite role for doxycycline in the symptomatic treatment of sinusitis.

Sinusitis is a common disorder with an incidence of 135 cases per 1000 in the US. It is the fifth commonest condition for which antibiotics are prescribed. Rhinosinusitis, the inflammation of the nose and the paranasal sinuses, is classified as acute, when symptoms last less than 4 weeks, subacute, when symptoms last 4-12 weeks, and chronic, when the symptom duration is greater than 12 weeks. Symptoms can be variable, ranging from a simple nasal discharge to a distressing headache, and can include fever, cough, nasal congestion, maxillary dental pain, and anosmia or hyposmia. Most patients are treated with antibiotics, such as amoxicillin/clavulanic acid or a cephalosporin, and topical corticosteroids may also be used. However, this new study raises serious concerns regarding the efficacy of conventional treatment methodologies.

References

1. Williamson IG, Rumsby K, Benge S,et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. 2007 Dec 5;298(21):2487-96.

2. Stalman W, van Essen GA, van der Graaf Y,et al.The end of antibiotic treatment in adults with acute sinusitis-like complaints in general practice? A placebo-controlled double-blind randomized doxycycline trial. Br J Gen Pract. 1997 Dec;47(425):794-9

3. Bucher HC, Tschudi P, Young J,et al.Effect of amoxicillin-clavulanate in clinically diagnosed acute rhinosinusitis: a placebo-controlled, double-blind, randomized trial in general practice. Arch Intern Med. 2003 Aug 11-25;163(15):1793-8

4. Osguthorpe JD.Adult rhinosinusitis: diagnosis and management. Am Fam Physician. 2001 Jan 1;63(1):69-76.