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 performa nce 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 analysi s 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 stra tegy. Antibiotics reduce the incidence of clinical failures by one half com pared to no treatment and, when coupled with clinical criteria-based diagno sis, present the most cost-effective treatment strategy. However, without a ntibiotics, symptoms in two thirds of patients improve by 14 days with no s erious complications. The risk of treatment failure does not differ signifi cantly between amoxicillin or folate inhibitors and newer, more expensive a ntibiotics. CONCLUSIONS: The current literature shows that treatment of uncomplicated A BR with amoxicillin or folate inhibitors and based on clinical criteria is the most cost-effective strategy.