Sinusitis is one of the most common reasons for visiting a doctor, with 20 million visits for this condition every year in the USA alone. There are four pairs of sinuses linked to the bony structures around the nose: the maxillary, frontal, ethmoidal and sphenoidal sinuses. In sinusitis, these membrane-lined air spaces become infected, which causes pain and discharge from the nose. Treatment options include decongestants, steroid drops or sprays, mucus-clearing drugs (mucolytics), antihistamines and antibiotics, and/or sinus puncture and lavage.
In most cases sinusitis accompanies viral cold infections where antibiotics are ineffective, but the few cases that have additional bacterial infections (one or two of every 100 patients with sinus symptoms) could benefit. Unfortunately it is difficult to distinguish between those who have bacterial infections and those who have not but it is important to avoid unnecessary use of antibiotics and thereby limit the potential for antibiotic resistance.
This systematic review drew together data from 59 separate studies that used a variety of antibiotics for simple maxillary sinus infection (i.e. non-complicated acute sinusitis in a person with a healthy immune system) in primary care settings. Six of the studies (747 participants) compared antibiotics to placebo and found that most of the participants got better within two weeks, regardless of whether they received the antibiotic or not. When antibiotics were given they somewhat speeded up recovery from sinusitis symptoms. In the remaining 53 studies comparing different antibiotics, none of the antibiotics were found to be superior to the others.
The small benefit gained by antibiotics may be overridden by the negative effects of the drugs. In addition to patient-related adverse effects (like skin rash and gastrointestinal problems, for example, diarrhoea, abdominal pain and vomiting), side effects include the risk of increased resistance to antibiotics among community-acquired pathogens.
This review found that antibiotics help some people a bit, but do not make a major difference to most people with acute maxillary sinusitis in primary care settings.