Are enough evidence from the use of antibiotics?
In a systematic review carried out by a Cochrane group, it concluded that in acute maxillary sinusitis antibiotics provide a minor improvement in simple
(uncomplicated) sinus infections. In spite of the fact that acute Rhinosinusitis can lead to severe complications, a study performed by Dr. Klossec also shows that, unfortunately, antibiotics do not seem to prevent these complications, and moreover, may produce a clear resistance to penicillin.
In a Cochrane systematic review on antibiotics in acute maxillary sinusitis authors observe that antibiotics provide a minor improvement in simple (uncomplicated) sinus infections.
However, 8 out of 10 patients improve without antibiotics within two weeks. The small benefit gained may be overridden by the negative effects of antibiotics, both on the patient and on the population in general. This review found that antibiotics help some people very slightly, but do not make a major difference to most people (Ahovuo-Saloranta).
In a double-blind, randomized, placebocontrolled factorial trial of 500 mg of amoxicillin 3 times per day for 7 days and 200 mg of budesonide in each nostril once per day for 10 days in patients with acute no recurrent sinusitis shows that neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the
primary care setting (Williamson et al).
A study by Prof. Klossek looked at an estimated study population of 12 million in France, and found 30 complicationsper year, of which 11 were intracraneal and 44 of the patients had actually had antibiotics before the complication, 70% of whom had a proven bacterial infection. Acute Rhinosinusitis can lead to severe complications; unfortunately, antibiotics do not seem to prevent these complications. What is more, there is a clear correlation between antibiotic sales and the prevalence of penicillin resistance to normal Streptococcus in those countries where antibiotic use is high.
1. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW, Jr., et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev 2008(2):CD000243.
2. Ian G. Williamson, I.G., Rumsby, K.BA; Benge S. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis. A Randomized Controlled Trial. JAMA. 2007;298(21):2487 2496.
3. M. Desrosiers, J-M Klossek, M. Benninger. Management of acute bacterial rhinosinusitis: current issues and future perspectives. International Journal of Clinical Practice. 2006; 60(2):190–200. DOI: 10.1111/j.1742- 1241.2006.00753.