Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis.

OBJECTIVES

To examine whether antibiotics are indicated in treating uncomplicated acute sinusitis and, if so, whether newer and more expensive antibiotics with broad spectra of antimicrobial activity are more effective than amoxycillin or folate inhibitors.

DESIGN

Meta-analysis of randomised trials.

SETTING

Outpatient clinics.

SUBJECTS

2717 patients with acute sinusitis or acute exacerbation of chronic sinusitis from 27 trials.

INTERVENTIONS

Any antibiotic versus placebo; amoxycillin or folate inhibitors versus newer, more expensive antibiotics.

MAIN OUTCOME MEASUREMENTS

Clinical failures and cures.

RESULTS

Compared with placebo, antibiotics decreased the incidence of clinical failures by half (risk ratio 0.54 (95% confidence interval 0.37 to 0.79)). Risk of clinical failure among 1553 randomised patients was not meaningfully decreased with more expensive antibiotics as compared with amoxycillin (risk ratio 0.86 (0.62 to 1.19); risk difference 0.9 fewer failures per 100 patients (1.4 more failures to 3.1 fewer failures per 100 patients)). The results were similar for other antibiotics versus folate inhibitors (risk ratio 1.01 (0.52 to 1.97)), but data were sparse (n=410) and of low quality.

CONCLUSIONS

Amoxycillin and folate inhibitors are essentially as effective as more expensive antibiotics for the initial treatment of uncomplicated acute sinusitis. Small differences in efficacy may exist, but are unlikely to be clinically important.