What is the efficacy of antimicrobial therapy for acute sinusitis (sinus infection)?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Several systematic reviews have also been published on antimicrobial therapy versus placebo, with at least 5 since 2005. Pediatric studies have also examined antimicrobial treatment. Evaluating the results of meta-analyses is essential to determine the quality of the studies included in the meta-analyses. A review of many of these studies indicates 2 common methodologic flaws: (1) many patients were declared eligible for study with only 7 days of symptoms (without a qualifier regarding whether these symptoms have begun to improve) and (2) images (plain radiographs, CT scans, ultrasounds, MRIs) were often used as diagnostic entry criteria. Accordingly, good logic exists to believe that many patients enrolled in these studies had uncomplicated viral upper respiratory tract infections rather than acute bacterial rhinosinusitis, thereby diluting the results. Nonetheless, most studies do show a modest benefit with the use of antimicrobials. This benefit may possibly be substantially magnified if more of the study patients actually had acute bacterial rhinosinusitis.

Sng and Wang evaluated 31 random control trials studying the clinical efficacy and side effects of cefuroxime axetil, telithromycin, amoxicillin/potassium clavulanate, levofloxacin, moxifloxacin and clarithromycin in the treatment of acute bacterial sinusitis. Among them, 9 studies were performed double-blinded with placebo controls. The results showed that, while antibiotics are more efficacious than placebo in the treatment of acute bacterial sinusitis, the risks of potential side effects need to be weighed against the potential benefits. [44]


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