Université Bordeaux 2, INSERM CIC 0005, Bordeaux, France.
Br J Clin Pharmacol. 2010 Sep;70(3):418-28. doi: 10.1111/j.1365-2125.2010.03710.x.
Determining bacterial aetiology of acute sinusitis is difficult without employing invasive procedures. Most episodes of acute sinusitis resolve spontaneously. Antibiotics have demonstrated efficacy for the treatment of acute bacterial sinusitis in clinical trials yet little is known of their effectiveness in real-life treatment settings.
Most cases of untreated acute sinusitis resolved spontaneously. Antibiotics were more effective when given within the first 10 days of treatment. This had no effect on later recurrence. Patients with poor oro-dental condition or recent antibiotic use may derive the most benefit from an antibiotic prescription and this should be considered by prescribers. The antibiotics used were found to be equally effective. Existing recommendations to identify acute sinusitis with high probability of bacterial origin, such as the French recommendations, fever or duration of symptoms fail to identify patients in whom antibiotics are more effective.
To assess the effectiveness of antibiotics in acute bacterial sinusitis.
This was a prospective cohort study with 2 months follow-up of 5640 patients with acute sinusitis included by a random sample from 1174 GPs and 120 ENT specialists. Main outcomes were short-term initial success, defined as the absence of prescription of (another) antibiotic or sinus lavage within 10 days, and lack of recurrence between the 11th and 60th day, after initial success.
Initial success was found in 88.7% (95% CI 85.1, 91.4%) of patients without antibiotic prescription at inclusion and 96.2% (95% CI 95.7, 96.7%) of patients prescribed antibiotics. The 10 day adjusted hazard ratio (HR) for treatment failure (new antibiotic prescription or sinus drainage) with initial antibiotics compared with no antibiotics was 0.30 (95% CI 0.21, 0.42) with no difference between antibiotics. Antibiotics were more effective in patients with poor oro-dental condition (HR 0.04, 95% CI 0.01, 0.20) and in patients who had already used antibiotics during the previous 2 months (HR 0.09, 95% CI 0.03, 0.28). For patients without failure at 10 days, recurrence between the 11th and 60th day was similar whether or not they had initially been prescribed an antibiotic, 94.1% (95% CI 93.4, 94.7%) and 93.4% (95%CI 90.3, 95.5%), respectively.
Most acute sinusitis cases not prescribed antibiotics resolve spontaneously. Antibiotics reduced by 3.3-fold the risk of failure within 10 days, without impact on later recurrence. The greatest benefit of antibiotics was found for patients with poor oro-dental condition or with antibiotic use within the previous 2 months.
如果不采用侵入性程序，确定急性鼻窦炎的细菌病因是很困难的。大多数急性鼻窦炎会自发缓解。抗生素已被证明对临床试验中急性细菌性鼻窦炎的治疗有效，但对于其在现实治疗环境中的疗效知之甚少。
未经治疗的急性鼻窦炎大多数情况下会自发缓解。抗生素在治疗的前 10 天内使用效果更好。这对以后的复发没有影响。口腔卫生条件差或近期使用抗生素的患者可能从抗生素处方中获益最多，医生应考虑这一点。所使用的抗生素被发现同样有效。现有的建议，如法国的建议，以确定具有高细菌性病因可能性的急性鼻窦炎，如高热或症状持续时间，无法识别抗生素治疗效果更好的患者。
评估抗生素治疗急性细菌性鼻窦炎的效果。
这是一项前瞻性队列研究，对 5640 例急性鼻窦炎患者进行了 2 个月的随访，这些患者是从 1174 名全科医生和 120 名耳鼻喉科专家中随机抽取的。主要结局为短期初始成功，定义为在 10 天内无（另一）抗生素处方或鼻窦冲洗，以及在初始成功后第 11 天至第 60 天无复发。
未在纳入时使用抗生素的患者中，有 88.7%（95%CI 85.1, 91.4%）初始成功，而使用抗生素的患者中，有 96.2%（95%CI 95.7, 96.7%）初始成功。与未使用抗生素相比，初始使用抗生素治疗失败（新抗生素处方或鼻窦冲洗）的 10 天调整后的风险比（HR）为 0.30（95%CI 0.21, 0.42），抗生素之间无差异。在口腔卫生条件差的患者（HR 0.04，95%CI 0.01，0.20）和在过去 2 个月内已使用抗生素的患者（HR 0.09，95%CI 0.03，0.28）中，抗生素更有效。对于在第 10 天无失败的患者，在第 11 天至第 60 天之间复发的情况相似，无论他们最初是否开了抗生素处方，分别为 94.1%（95%CI 93.4, 94.7%）和 93.4%（95%CI 90.3, 95.5%）。
大多数未开抗生素的急性鼻窦炎病例会自发缓解。抗生素将 10 天内失败的风险降低了 3.3 倍，但对以后的复发没有影响。抗生素最大的益处是口腔卫生条件差或在过去 2 个月内使用过抗生素的患者。
