Piromchai Patorn, Thanaviratananich Sanguansak, Laopaiboon Malinee
Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 40002.
Cochrane Database Syst Rev. 2011 May 11(5):CD008233. doi: 10.1002/14651858.CD008233.pub2.
Chronic rhinosinusitis (CRS) is a common health problem which significantly affects quality of life. A wide range of medical and surgical therapies have been used to treat CRS. Both systemic and topical antibiotics are used with the aim of eliminating infection and inflammation, altering bacterial biofilm formation, reversing ostial occlusion and improving symptoms. Various groups of systemic antibiotics have been studied; clinical cure rates reported are inconsistent and range from 50% to 95%.
To determine the effectiveness and adverse reactions associated with systemic antibiotic therapy for CRS in adults.
We searched the Cochrane ENT Group Trials Register; CENTRAL (2010, Issue 2); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 10 June 2010.
Randomised controlled trials (RCTs) comparing systemic antibiotics with placebo for chronic rhinosinusitis in adults.
Two authors extracted data independently, compared results and resolved disagreements by discussion. We assessed treatment effect by calculating the risk ratio (RR) and 95% confidence intervals (CI) of cure at a specific time point for each trial. We used mean difference (MD) and 95% CI for continuous variables (severity scores, duration of symptoms, etc.).
We included one study involving 64 patients. We assessed the overall risk of bias in this study as high. The study reported that roxithromycin could reduce the mean response score of patients by 0.73 points on a 1 to 6-point scale (95% CI 0.32 to 1.14, P = 0.0005) compared to those on placebo at three months after the start of treatment. This study also used sinonasal outcome test-20 (SNOT-20) comparing between pre and post-treatment at six, 12 and 24 weeks. The mean change in SNOT-20 from baseline at 24 weeks in the roxithromycin group was not significantly more than in the placebo group, at 0.27 points (95% CI -0.24 to 0.78, P = 0.30) on a 0 to 5-point scale.
AUTHORS' CONCLUSIONS: There is limited evidence from one small study to support the use of systemic antibiotics for the curative treatment of chronic rhinosinusitis in adults. Further good quality trials, with large sample sizes, are needed to evaluate the use of antibiotics in chronic rhinosinusitis.
慢性鼻-鼻窦炎（CRS）是一个常见的健康问题，严重影响生活质量。已采用多种药物和手术疗法来治疗CRS。全身和局部使用抗生素的目的是消除感染和炎症、改变细菌生物膜形成、逆转窦口阻塞并改善症状。已对各类全身用抗生素进行了研究；报道的临床治愈率不一致，范围在50%至95%之间。
确定全身用抗生素治疗成人CRS的有效性和不良反应。
我们检索了Cochrane耳鼻喉科组试验注册库；Cochrane系统评价数据库（2010年第2期）；PubMed；EMBASE；护理学与健康领域数据库；科学引文索引；生物学文摘数据库；剑桥科学文摘数据库；国际标准随机对照试验编号库以及其他已发表和未发表试验的来源。最近一次检索日期为2010年6月10日。
比较全身用抗生素与安慰剂治疗成人慢性鼻-鼻窦炎的随机对照试验（RCT）。
两名作者独立提取数据，比较结果并通过讨论解决分歧。我们通过计算每项试验在特定时间点治愈的风险比（RR）和95%置信区间（CI）来评估治疗效果。对于连续变量（严重程度评分、症状持续时间等），我们使用均数差（MD）和95%CI。
我们纳入了一项涉及64例患者的研究。我们评估该研究的总体偏倚风险为高。该研究报告称，与安慰剂组相比，治疗开始三个月后，罗红霉素可使患者的平均反应评分在1至6分的量表上降低0.73分（95%CI 0.32至1.14，P = 0.0005）。该研究还使用鼻窦结局测试-20（SNOT-20）在6周、12周和24周时比较治疗前后情况。罗红霉素组在24周时SNOT-20相对于基线的平均变化在0至5分的量表上为0.27分（95%CI -0.24至0.78，P = 0.30），并不显著高于安慰剂组。
一项小型研究的证据有限，不足以支持使用全身用抗生素治愈成人慢性鼻-鼻窦炎。需要进一步开展高质量、大样本量的试验来评估抗生素在慢性鼻-鼻窦炎中的应用。
