ARE AMOXICILLIN AND FOLATE INHIBITORS AS EFFECTIVE AS OTHER ANTIBIOTICS FOR ACUTE SINUSITIS - A METAANALYSIS

Objectives: To examine whether antibiotics are indicated in treating u ncomplicated acute sinusitis and, if so, whether newer and more expens ive antibiotics with broad spectra of antimicrobial activity are more effective than amoxycillin or folate inhibitors. Design: Meta-analysis of randomised trials. Setting: Outpatient clinics. Subjects: 2717 pat ients with acute sinusitis or acute exacerbation of chronic sinusitis from 27 trials. Interventions: Any antibiotic versus placebo; amoxycil lin or folate inhibitors versus newer, more expensive antibiotics. Mai n outcome measurements: Clinical failures and cures. Results: Compared with placebo, antibiotics decreased the incidence of clinical failure s by half (risk ratio 0.54 (95% confidence interval 0.37 to 0.79)). Ri sk of clinical failure among 1553 randomised patients was not meaningf ully decreased with more expensive antibiotics as compared with amoxyc illin (risk ratio 0.86 (0.62 to 1.19); risk difference 0.9 fewer failu res per 100 patients (1.4 more failures to 3.1 fewer failures per 100 patients)). The results were similar for other antibiotics versus fola te inhibitors (risk ratio 1.01 (0.52 to 1.97)), but data were sparse ( n = 410) and of low quality. Conclusions: Amoxycillin and folate inhib itors are essentially as effective as more expensive antibiotics for t he initial treatment of uncomplicated acute sinusitis. Small differenc es in efficacy may exist, but are unlikely to be clinically important.