ANTIMICROBIAL TREATMENT IN ACUTE MAXILLARY SINUSITIS - A METAANALYSIS

Objective. The aims of this study were to assess which antibiotic is m ost effective in the treatment of acute maxillary sinusitis in otherwi se healthy adults and adolescents, and which has the fewest side effec ts. Design. To assess the short-term effects of antimicrobial treatmen ts, a meta-analysis was performed using Mantel-Haenszel procedures on 16 comparative, randomized studies with a total number of 3358 patient s. No placebo-controlled studies were available. Antimicrobial treatme nts were categorized according to type, spectrum, beta-lactamase inhib ition, and bactericidal effect. Outcomes were clinical cure, clinical success, and adverse events. Results. When studies were analyzed separ ately, we found significant differences between cefpodoxim and cefaclo r 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 clin ical cure, and macrolids were more effective than penicillins in relat ion to clinical success, whereas cephalosporins caused significantly l ess adverse events than penicillins. When studies were stratified (sta ndard classic meta-analysis), antibiotics with beta-lactamase inhibiti on 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. Conclusi on. Differences in outcome between antimicrobial treatments of acute s inusitis in otherwise healthy adults and adolescents appear to be smal l. Therefore, the cheapest antimicrobial treatment can be selected. (C ) 1991 Elsevier Science Inc.