Antimicrobial treatment in acute maxillary sinusitis: a meta-analysis.

OBJECTIVE The aims of this study were to assess which antibiotic is most effective in the treatment of acute maxillary sinusitis in otherwise healthy adults and adolescents, and which has the fewest side effects. DESIGN To assess the short-term effects of antimicrobial treatments, a meta-analysis was performed using Mantel-Haenszel procedures on 16 comparative, randomized studies with a total number of 3358 patients. No placebo-controlled studies were available. Antimicrobial treatments were categorized according to type, spectrum, beta-lactamase inhibition, and bactericidal effect. Outcomes were clinical cure, clinical success, and adverse events. RESULTS When studies were analyzed separately, we found significant differences between cefpodoxim and cefaclor in relation to clinical cure, and between loracarbef and doxycycline in relation to clinical success. When data was pooled, sulphonamides were significantly more effective than penicillins in relation to clinical cure, and macrolids were more effective than penicillins in relation to clinical success, whereas cephalosporins caused significantly less adverse events than penicillins. When studies were stratified (standard classic meta-analysis), antibiotics with beta-lactamase inhibition offered significantly more clinical cures than antibiotics without beta-lactamase inhibition. However, this significant effect was only due to one study from Southern Europe, published before 1991. CONCLUSION Differences in outcome between antimicrobial treatments of acute sinusitis in otherwise healthy adults and adolescents appear to be small. Therefore, the cheapest antimicrobial treatment can be selected.

[1]  J. Gratz,et al.  Comparison of cyclacillin and amoxicillin for therapy for acute maxillary sinusitis , 1986, Antimicrobial Agents and Chemotherapy.

[2]  H. Lamberts,et al.  Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography. , 1992, BMJ.

[3]  Howard D. White,et al.  SCIENTIFIC COMMUNICATION AND LITERATURE RETRIEVAL , 2019, The Handbook of Research Synthesis and Meta-Analysis.

[4]  D. Bruynzeel,et al.  Onset of penicillin rashes: relation between type of penicillin administered and type of immune reactivity. , 1986, Allergy.

[5]  W. Gaus,et al.  [Efficiency of homeopathic preparation combinations in sinusitis. Results of a randomized double blind study with general practitioners]. , 1989, Arzneimittel-Forschung.

[6]  G P Samsa,et al.  Randomized controlled trial of 3 vs 10 days of trimethoprim/sulfamethoxazole for acute maxillary sinusitis. , 1995, JAMA.

[7]  C. Stafford.  The Clinician's View of Sinusitis , 1990, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[8]  G. H. Bock.  NHG-standaard Sinusitis , 1993 .

[9]  L. Hedges,et al.  The Handbook of Research Synthesis , 1995 .

[10]  N. Nørrelund.  [Treatment of sinusitis in general practice. A controlled investigation of pivampicillin (Pondocillin)]. , 1978, Ugeskrift for laeger.

[11]  T. Chalmers,et al.  Meta-analyses of randomized controlled trials. , 1987, The New England journal of medicine.

[12]  J. Fleiss,et al.  Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique. , 1991, Journal of clinical epidemiology.

[13]  J. Kievit,et al.  Acute maxillary sinusitis in general practice: a decision problem. , 1994, Scandinavian journal of primary health care.

[14]  F. V. Buchem,et al.  Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis , 1997, The Lancet.

[15]  S. Knight,et al.  Comparative Study of Cefuroxime Axetil and Amoxycillin in the Treatment of Acute Sinusitis in General Practice , 1989, The Journal of international medical research.

[16]  W. Haenszel,et al.  Statistical aspects of the analysis of data from retrospective studies of disease. , 1959, Journal of the National Cancer Institute.

[17]  K. Calhoun,et al.  Multicenter comparison of clarithromycin and amoxicillin in the treatment of acute maxillary sinusitis. , 1993, Archives of family medicine.

[18]  S. Spector,et al.  Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with acute bacterial maxillary sinusitis. , 1992, The American journal of medicine.

[19]  J. Dubois,et al.  Efficacy of Clarithromycin vs. Amoxicillin/Clavulanate in the Treatment of Acute Maxillary Sinusitis , 1993, Ear, nose, & throat journal.

[20]  R. Casiano.  Azithromycin and amoxicillin in the treatment of acute maxillary sinusitis. , 1991, The American journal of medicine.

[21]  R. Ferguson,et al.  Cefaclor vs amoxicillin in the treatment of acute, recurrent, and chronic sinusitis. , 1993, Archives of family medicine.

[22]  G. Hordijk,et al.  Co-amoxiclav in recurrent acute otitis media: placebo controlled study. , 1991, BMJ.

[23]  I. Jonas,et al.  [A study of spontaneous cure of sinusitis (author's transl)]. , 1981, HNO.

[24]  P Hjortdahl,et al.  Randomised, double blind, placebo controlled trial of penicillin V and amoxycillin in treatment of acute sinus infections in adults , 1996, BMJ.

[25]  Y. van der Graaf,et al.  Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice. , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[26]  P. Haan,et al.  Onset of Penicillin Rashes: Relation between Type of Penicillin Administered and Type of Immune Reactivity , 1986 .

[27]  T. Verheij,et al.  Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[28]  W. Scheld,et al.  Loracarbef (LY163892) vs Amoxicillin/Clavulanate in Bacterial Maxillary Sinusitis , 1992, Ear, nose, & throat journal.

[29]  R. Warren,et al.  Rhinocerebral mucormycosis due to absidia corymbifera , 1987 .

[30]  M. Simonet,et al.  Comparison of cefpodoxime proxetil with cefaclor in the treatment of sinusitis. , 1990, The Journal of antimicrobial chemotherapy.

[31]  S Greenland,et al.  Re: "The impact of confounder selection criteria on effect estimation. , 1989, American journal of epidemiology.

[32]  R. Ziering,et al.  The efficacy and safety of once-daily ceftibuten compared with co-amoxiclav in the treatment of acute bacterial sinusitis. , 1992, Journal of chemotherapy.

[33]  J. Pukander,et al.  The comparative efficacy and safety of clarithromycin and amoxycillin in the treatment of outpatients with acute maxillary sinusitis. , 1991, The Journal of antimicrobial chemotherapy.