Antibiotics Provide Marginal Benefits in Adults With Acute Rhinosinusitis

A merger of data from 2 reviews found no place for antibiotics in adults with uncomplicated acute rhinosinusitis.

A merger of data from 2 reviews published in the Cochrane Database of Systematic Reviews found no evidence for the use of antibiotics in adults with uncomplicated acute rhinosinusitis as a result of finding only marginal evidence in adults diagnosed clinically or confirmed with imaging.

The updated review included 15 trials involving 3057 participants and was undertaken in order to assess the effects of antibiotics, placebo, or no treatment in adults with acute rhinosinusitis in ambulatory care settings. These 15 trials included 10 from the study authors’ 2012 review and 5 legacy trials resulting from merging the 2 reviews.

The data suggested that antibiotics can shorten the time to cure, but only 5 to 11 more people per 100 will be cured faster with antibiotics vs placebo or no treatment; clinical diagnosis (odds ratio [OR], 1.25, 95% CI 1.02-1.54; number needed to treat for an additional beneficial outcome (NNTB) 19; 95% CI, 10-205; I²= 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR, 1.57; 95% CI, 1.03-2.39; NNTB 10; 95% CI, 5-136; I²= 0%; 3 trials; moderate-quality evidence). 

Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR, 4.89; 95% CI, 1.75-13.72; NNTB 4; 95% CI, 2-15; 1 trial; moderate-quality evidence) and purulent secretion also resolved faster with antibiotics (OR, 1.58; 95% CI, 1.13-2.22; NNTB 10; 95% CI, 6-35; I²= 0%; 3 trials; high-quality evidence). More people experienced side effects with antibiotics (OR, 2.21; 95%CI, 1.74-2.82; number needed to treat for an additional harmful outcome [NNTH] 8; 95% CI, 6-12; I²= 16%; 10 trials; high-quality evidence) and 5 fewer people per 100 will experience clinical failure if they receive antibiotics (Peto OR, .48; 95% CI, .36-.63; NNTH 19; 95% CI, 15-27; I²= 21%; 12 trials; high-quality evidence).

The investigators concluded that the evidence for a potential benefit of antibiotics in adults with acute rhinosinusitis is marginal and “needs to be seen in the context of the risk of adverse effects.” Therefore, when considering the problems facing antibiotic resistance and the low rate of serious complications, there is insufficient evidence supporting the use of antibiotics in acute rhinosinusitis. However, there also remains “insufficient clinical data to enable subgroup analysis of people who probably could benefit more from antibiotics, for example people with high fever, severe facial pain, or rhinorrhea.”

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Lemiengre MB, van Driel ML, Merenstein D, Liira H, Mäkelä M, De Sutter AI. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018;9:CD006089