Medications for acute sinusitis
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Antibiotics for Acute Sinusitis: Effectiveness and Considerations
Antibiotics are commonly prescribed for acute sinusitis, but their benefit is modest. Meta-analyses and large studies show that antibiotics like amoxicillin, amoxicillin-clavulanate, and cefuroxime provide a small but statistically significant improvement in symptom resolution compared to placebo, with a number needed to treat (NNT) of about 6 to prevent one treatment failure in children and similar modest benefits in adults 35. However, most cases of acute sinusitis resolve spontaneously without antibiotics, and the risk of adverse events, such as diarrhea, is higher in those treated with antibiotics 358. Antibiotics are most beneficial for patients with a higher likelihood of bacterial infection, such as those with poor dental health or recent antibiotic use . Overuse of antibiotics can contribute to resistance, so they should be reserved for carefully selected patients 39.
Systemic Corticosteroids for Acute Sinusitis: Adjunctive Use
Systemic corticosteroids, when used in addition to antibiotics, may provide modest short-term relief of symptoms such as facial pain and nasal congestion in adults with acute sinusitis 12. The benefit is seen mainly in the first week of treatment, but the effect is modest and the evidence is limited, with a significant risk of bias in the available studies 12. Systemic corticosteroids as monotherapy (without antibiotics) do not show benefit for acute sinusitis . Reported side effects are generally mild, such as nausea or gastric complaints, and do not differ significantly from placebo . There is no evidence on long-term outcomes or relapse rates with corticosteroid use 12.
Intranasal Corticosteroids (INCS) for Acute Sinusitis: Monotherapy and Adjunctive Therapy
Intranasal corticosteroids (INCS) can be used either alone or as an add-on to antibiotics for acute sinusitis. Evidence shows that INCS modestly increase the likelihood of symptom improvement or resolution compared to placebo, with higher doses providing a slightly greater effect 467. The benefit is clinically relevant but modest, and no significant adverse events or differences in recurrence rates have been reported 467. INCS are considered safe and may be especially useful for patients with mild to moderate symptoms or as an adjunct to antibiotics.
Combination Therapy and Real-World Effectiveness
Some studies have examined the combination of antibiotics and topical nasal steroids, but results are mixed. One large randomized trial found that neither antibiotics nor topical steroids alone or in combination were effective in primary care settings for acute sinusitis, though secondary analysis suggested nasal steroids might help those with less severe symptoms . In real-life practice, most untreated cases resolve on their own, and antibiotics are most effective when given early, especially in patients with certain risk factors .
Conclusion
For acute sinusitis, most cases resolve without medication. Antibiotics offer a small benefit in symptom resolution, mainly for patients with a higher likelihood of bacterial infection, but increase the risk of side effects. Systemic corticosteroids may provide short-term relief when used with antibiotics, but not as monotherapy. Intranasal corticosteroids are safe and modestly effective, either alone or with antibiotics. Careful patient selection and consideration of risks and benefits are essential when choosing medications for acute sinusitis.
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