Antibiotics Offer No Advantage in Sinusitis Treatment

A new study suggests that there is no clinically meaningful reason for prescribing antibiotics to treat acute rhinosinusitis.

Researchers at Washington University (St. Louis, MO, USA) conducted a randomized, placebo-controlled trial of 166 adults (36% male; 78% Caucasian) with uncomplicated, acute rhinosinusitis to determine the incremental effect of amoxicillin treatment compared to symptomatic treatments. The patients were randomized to a 10-day course of amoxicillin (85 patients) or placebo (81 patients), administered in three doses per day. All patients received a 5-7 day supply of symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed. The main outcome measure was improvement in disease-specific quality of life after 3 to 4 days of treatment; secondary outcomes included the patient's retrospective assessment of change in sinus symptoms and functional status, recurrence or relapse, and satisfaction with and adverse effects of treatment.

The results showed that the there was no significant difference between groups on day 3 and on day 10, but there was one on day 7 in favor of amoxicillin. There was no statistically significant difference in reported symptom improvement at day 3 or at day 10, whereas at day 7 more participants treated with amoxicillin reported symptom improvement (74% versus 56%, respectively), which was evident in nasal obstruction as recorded by a doctor. No between-group differences were found for any other secondary outcomes, and no serious adverse events occurred in either group. The study was published in the February 15, 2012, issue of the Journal of the American Medical Association (JAMA).

“There is now a considerable body of evidence from clinical trials conducted in the primary care setting that antibiotics provide little if any benefit for patients with clinically diagnosed acute rhinosinusitis,” concluded lead author Jay Piccirillo, MD, and colleagues, adding that their study “provides further evidence for what we've really suspected for a long time.”

Rhinosinusitis is an inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days. The vast majority of cases of sinusitis are caused by viruses and will therefore resolve without antibiotics; however, if symptoms do not resolve within 10 days, amoxicillin is a reasonable antibiotic to use first for treatment, with added clavulanate being indicated when the patient's symptoms do not improve on amoxicillin alone.

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