Diagnosis and treatment of uncomplicated acute bacterial rhinosinusitis: Summary of the Agency for Health Care Policy and Research evidence-based report

PURPOSE The goal was to critically examine evidence regarding the performance of diagnostic tests and the efficacy of antibiotic and other treatments for uncomplicated acute bacterial rhinosinusitis (ABR). METHODS Scientific literature was reviewed, and meta-analysis methods were used to assess diagnostic test and antibiotic efficacy. A decision analysis and cost-effective analysis were performed. RESULTS Although more sensitive than clinical examination for diagnosis of ABR, sinus radiograms are not cost-effective as an initial management strategy. Antibiotics reduce the incidence of clinical failures by one half compared to no treatment and, when coupled with clinical criteria-based diagnosis, present the most cost-effective treatment strategy. However, without antibiotics, symptoms in two thirds of patients improve by 14 days with no serious complications. The risk of treatment failure does not differ significantly between amoxicillin or folate inhibitors and newer, more expensive antibiotics. CONCLUSIONS The current literature shows that treatment of uncomplicated ABR with amoxicillin or folate inhibitors and based on clinical criteria is the most cost-effective strategy. (Otolaryngol Head Neck Surg 2000;122:1–7.)

[1]  M. Revonta.  Ultrasound in the diagnosis of maxillary and frontal sinusitis. , 1980, Acta oto-laryngologica. Supplementum.

[2]  C. Carenfelt,et al.  Analysis of symptoms and clinical signs in the maxillary sinus empyema. , 1988, Acta oto-laryngologica.

[3]  S. Spector,et al.  Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis. , 1986, The Journal of allergy and clinical immunology.

[4]  A. Axelsson,et al.  Treatment of acute maxillary sinusitis. A comparison of four different methods. , 1970, Acta oto-laryngologica.

[5]  G P Samsa,et al.  Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination. , 1992, Annals of internal medicine.

[6]  W. Stalman,et al.  The end of antibiotic treatment in adults with acute sinusitis-like complaints in general practice? A placebo-controlled double-blind randomized doxycycline trial. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

[7]  R. McNeill.  Comparison of the Findings on Transillumination, X-Ray and Lavage of the Maxillary Sinus , 1963, The Journal of Laryngology & Otology.

[8]  D. Kennedy,et al.  Adult Rhinosinusitis Defined , 1997, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[9]  M. Aitken,et al.  Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. , 1998, Archives of pediatrics & adolescent medicine.

[10]  David W. Kennedy,et al.  Adult Rhinosinusitis Defined , 1997 .

[11]  M. Pietola,et al.  An ultrasound device in the diagnosis of acute maxillary sinusitis. , 1997, Acta oto-laryngologica. Supplementum.

[12]  A. Axelsson,et al.  Symptoms and signs of acute maxillary sinusitis. , 1976, ORL; journal for oto-rhino-laryngology and its related specialties.

[13]  A. Geretti,et al.  Laboratory Diagnosis , 2021, Hepatitis C: Epidemiology, Prevention and Elimination.

[14]  A. Kinmonth,et al.  Acute maxillary sinusitis in general practice: the relation between clinical picture and objective findings , 1996 .

[15]  A. Axelsson,et al.  Treatment of Acute Maxillary Sinusitis , 1981 .

[16]  T. Burke,et al.  Comparison of sinus x-rays with computed tomography scans in acute sinusitis. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[17]  J. Gwaltney.  Acute Community-Acquired Sinusitis , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  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.

[19]  L. Trabulsi,et al.  The therapeutic effects of cyclacillin in acute sinusitis: in vitro and in vivo correlations in a placebo-controlled study. , 1973, Current medical research and opinion.

[20]  C. Carenfelt,et al.  Etiological diagnosis in sinusitis: Ultrasonography as clinical complement. , 1985, The Laryngoscope.

[21]  E. Wald,et al.  Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. , 1986, Pediatrics.

[22]  I. Helin,et al.  Acute sinusitis in children--symptoms, clinical findings and bacteriology related to initial radiologic appearance. , 1982, International journal of pediatric otorhinolaryngology.

[23]  C. Jensen,et al.  Radiography and Ultrasonography in Paranasal Sinusitis , 1987, Acta radiologica.

[24]  S. D. de Ferranti,et al.  Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis , 1998, BMJ.

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

[26]  D. Kennedy.  Medical Management of Sinusitis: Educational Goals and Management Guidelines , 1995, The Annals of otology, rhinology & laryngology. Supplement.

[27]  M. Mäkelä,et al.  Diagnosing acute maxillary sinusitis in primary care: a comparison of ultrasound, clinical examination and radiography. , 1998, Rhinology.