A large randomized trial showing no effect of antibiotics on acute rhinosinusitis in adults does not inspire a change in recommendations for family physicians.
Perhaps a collaborative study from 10 community practices in Missouri has prompted you to rethink the way you prescribe antibiotics for adults with acute sinusitis. There's only "limited" evidence to support prescribing antibiotics for this condition, say the authors from Washington University School of Medicine in St Louis, and now they produce some evidence against it.
The randomized controlled trial showed that a 10-day course of amoxicillin (1500 mg/d) was no better than placebo at relieving symptoms within 3 days.
The study, reported in JAMA, involved 166 adults with uncomplicated acute rhinosinusitis. There was also no significant difference in symptoms after 10 days in the antibiotic group, although members of the treatment group felt somewhat better than placebo-treated subjects at 7 days.
Does this redefine adult sinusitis as another example of overuse of antibiotics?
Most acute sinusitis is viral in any case, observe family physician Ann Aring, MD, and pharmacist Miriam Chan of Columbus, Ohio, in a recent review in American Family Physician about adult sinusitis. Nonetheless, they recommend narrow-spectrum antibiotics such as amoxicillin for adults whose symptoms don't improve after 7 days, or for those whose sinusitus worsens at any time.
The Missouri study notwithstanding, Aring and Chan stand firm in this recommendation. Although the study was well-designed, they say, it looked only at young adults who were otherwise healthy. In addition, they point out that the study period ranged from 2006 to 2009, when antibiotic-resistant bacteria were not as prevalent as it is now.
Another review on the role of antibiotics in sinusitis, published this month in Current Opinion in Infectious Diseases, says that the evidence base is not sufficient to justify antibiotics even for chronic sinusitis in adults. For those with acute sinusitis, the evidence is solid only for specific subgroups (although a well-designed study showed that antibiotics do shorten the duration of sinusitus symptoms in children). The authors from the University of Pittsburgh School of Medicine say that future studies should use nasal or endoscopic cultures to clarify which adults may benefit.