Sinusitis (acute rhinosinusitis)

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

Abstract

INTRODUCTION: Acute rhinosinusitis is defined pathologically by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1% to 5% of the adult population each year in Europe. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with clinically diagnosed acute rhinosinusitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 12 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, amoxicillin-clavulanic acid [co-amoxiclav], doxycycline, cephalosporins, macrolides; long-course regimens), corticosteroids (intranasal), decongestants (xylometazoline, phenylephrine, pseudoephedrine), and saline nasal washes.

Cite as

Ah-See K. Sinusitis (acute rhinosinusitis). Clinical Evidence 2015; 04:511.

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General background

Acute rhinosinusitis is a commonly clinically diagnosed condition in primary care. It affects 1% to 5% of the adult population each year in Europe.

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Focus of the review

Antibiotics are frequently prescribed for this condition. This review focuses on the evidence for the use of topical corticosteroids and antibiotics in this condition.

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Comments on evidence

The evidence presented comes from RCTs and systematic reviews of RCTs. However, the overall quality of the evidence from these studies is low.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, June 2011, to October 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 125 studies. Appraisal of titles and abstracts led to the exclusion of 113 studies and the further review of 12 full publications. Of the 12 full articles evaluated, three systematic reviews and one RCT were added at this update.

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Additional information

No studies included the treatment of severe acute rhinosinusitis; the conclusions are limited to mild-to-moderate clinically diagnosed acute rhinosinusitis. The incidence of adverse effects appears to be higher in people treated with antibiotics compared to placebo.

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Substantive changes at this update

Corticosteroids (intranasal) versus placebo One systematic review updated.[11] One systematic review reporting on a previously included RCT added.[12] One new RCT added.[13] Categorisation unchanged (likely to be beneficial).

Antibiotics (amoxicillin, amoxicillin-clavulanic acid [co-amoxiclav], doxycycline, cephalosporins, macrolides) One systematic review added.[15] Existing evidence re-evaluated; categorisation changed to 'unknown effectiveness'.

Latest citations

Intranasal steroids for acute sinusitis. ( 07 April 2015 )

Antibiotics for acute maxillary sinusitis in adults. ( 07 April 2015 )