A comparison of common treatments for acute sinusitis that included an antibiotic and a topical steroid found neither more effective than placebo, according to a study in today’s issue of the Journal of the American Medical Association.
The study’s authors point out that, despite the clinical uncertainty as to a bacterial cause, antibiotic prescribing rates remain as high as 92% in the United Kingdom and 85%to 98% in the United States.
“Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring,” the authors write.
Ian G. Williamson, M.D., of the University of Southampton, England, and colleagues conducted a double-blind randomized placebo-controlled trial to determine the effectiveness of the antibiotic amoxicillin and topical steroid budesonide in acute maxillary sinusitis (rhinosinusitis; inflammation of the nasal cavity and sinuses).
The study included 240 adults with acute nonrecurrent sinusitis. Patients were randomized to 1 of 4 treatment groups: antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 ìg of budesonide in each nostril once per day for 10 days); placebo antibiotic and nasal steroid; antibiotic and placebo nasal steroid; placebo antibiotic and placebo nasal steroid.
The researchers found that the proportions of patients with symptoms lasting 10 or more days were 29% for amoxicillin vs. 33.6% for no amoxicillin; and 31.4% for topical budesonide vs. 31.4% for no budesonide.
“Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition.”
JAMA – December 5, 2007;298:2487-96. www.jama.com