Systemic antibiotics for chronic rhinosinusitis in adults

Piromchai P, Thanaviratananich S, Laopaiboon M

Published Online:

May 11, 2011

Chronic rhinosinusitis is a common health problem which significantly affects quality of life. Various groups of antibiotics have been studied in the treatment of chronic rhinosinusitis but the results are controversial and there are problems with study quality. In this review we decided to include only trials which compared systemic antibiotics with a placebo. We found only one study that met our inclusion criteria, involving 64 patients. The results found that roxithromycin could reduce the mean response score of patients by 0.73 points on a 1 to 6-point scale compared to those on placebo at three months after the start of treatment (this is an indication of their response to treatment; lower is better). The effect was small and not clinically significant. We assessed the overall risk of bias in this study as high. There is limited evidence on the question of whether or not antibiotics help to cure chronic rhinosinusitis in adults. Further good quality, large trials are needed to evaluate the use of antibiotics in chronic rhinosinusitis.

Abstract (click to read)

Background:

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%.

Objectives:

To determine the effectiveness and adverse reactions associated with systemic antibiotic therapy for CRS in adults.

Search strategy:

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Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials.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.

Selection criteria:

Randomised controlled trials (RCTs) comparing systemic antibiotics with placebo for chronic rhinosinusitis in adults.

Data collection and analysis:

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.).

Main results:

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.

This record should be cited as:

Piromchai P, Thanaviratananich S, Laopaiboon M. Systemic antibiotics for chronic rhinosinusitis without nasal polyps in adults. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD008233. DOI: 10.1002/14651858.CD008233.pub2

Assessed as up to date:

June 10, 2010

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Ear, nose, & throat > Nose & sinus > Sinusitis

Infectious disease > Respiratory infections > Sinusitis

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Systemic antibiotics for chronic rhinosinusitis in adults

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