Amoxicillin for acute sinusitis ‘of no benefit’
MedWire News: A 10-day course of amoxicillin is no more effective than placebo for the treatment of acute rhinosinusitis, results of a randomized controlled trial show.
The trial was limited to patients with acute uncomplicated sinusitis, however, and the authors say that antibiotics may be beneficial in people with more complicated disease.
Jane Garbutt (Washington University, St Louis, Missouri, USA) and team recruited 166 adults from 10 community practices who had been diagnosed with uncomplicated, acute sinusitis.
They were randomly assigned to receive amoxicillin 1500 mg/day or placebo; all patients also received symptomatic relief for pain, fever, cough, and nasal congestion to be used as needed.
The primary endpoint was the change in disease-specific quality of life after 3 days of treatment, measured using the SinoNasal Outcome Test (SNOT)-16. This is a validated instrument that assesses functional limitations, physical problems, and emotional consequences of rhinosinusitis.
SNOT-16 scores were similar at baseline between the amoxicillin and placebo groups, at 1.71 and 1.70, respectively, the researchers report.
Subsequently, scores had fallen by a similar amount in both groups at day 3 (mean between-group difference 0.03) and day 10 (mean difference 0.01), although on day 7 scores were significantly lower in the amoxicillin group (mean difference 0.19).
In terms of secondary outcomes, there were no between-group differences in symptoms on day 3 or day 10, or in days missed from work/unable to perform usual activities, rates of relapse and recurrence at 28 days, or satisfaction with treatment.
However, patients in the placebo group were twice as likely as those in the amoxicillin group to phone or visit their physician for additional advice.
Finally, there were no serious adverse events in either group and the frequency of adverse events did not differ between the groups.
"Our findings support recommendations to avoid routine antibiotic treatment for patients with uncomplicated acute rhinosinusitis," write Garbutt et al in the Journal of the American Medical Association.
"It is important to note that patients with symptoms indicative of serious complications were excluded from this trial and likely need a different management strategy."
By Joanna Lyford