Small benefit for antibiotics in sinusitis but consider risks
Antibiotics provide a small benefit in acute sinusitis, but this must be weighed against potential adverse effects for individuals and the population as a whole, the authors of a Cochrane review conclude (Cochrane
Database of Systematic Reviews 2008;
issue 2).
The review uncovered five studies involving 631 participants that showed
a slight statistical difference in favour of antibiotics in primary care
treatment of uncomplicated acute sinusitis, compared with placebo (pooled
relative risk 0.66, 95 per cent confidence interval 0.44–0.98).
There was some evidence that patients treated with antibiotics improved
faster and 90 per cent of patients treated with antibiotics improved
within two weeks, but so did 80 per cent of patients given placebo.
The researchers conclude that the small benefit of antibiotics needs
to be weighed against the potential for adverse effects, including those
associated with resistance to
antibiotics among community-acquired pathogens, which may be increased
by widespread prescribing of antibiotics and the use of low doses, long
treatment durations and broad-spectrum agents.
Three other Cochrane reviews of antibiotics were also published this
week. One showed that three
days of antibiotic therapy is as effective as five days’ therapy for
non-severe pneumonia in children under five years of age.
Another found
little or
no evidence that antibiotics reduce pain or secondary haemorrhage rates following tonsillectomy,
leading the reviewers to advise that caution be used when prescribing
antibiotics
routinely to all tonsillectomy patients.
A further review found no
published data to recommend the optimum duration of treatment with intravenous antibiotics for chest exacerbations in
cystic fibrosis. This last issue has important clinical and financial
implications, the reviewers stress, and so an adequately powered randomised
controlled trial is needed to provide a conclusive answer. |
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