Treatment of Acute Maxillary Sinusitis

Axelsson, A.; Chidekel, N.; Grebelius, N.; Jensen, C.

doi:10.3109/00016487009181861

Cited by 73 publications

(3 citation statements)

References 9 publications

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“…Placebo-controlled clinical trials to evaluate antibiotic treatment have had conflicting results, likely due to differences in diagnostic criteria and outcome assessment. Studies requiring confirmatory tests such as x-ray have tended to show treatment benefit, 4–7 but meta-analyses of these studies have generally concluded that clinical benefit with antibiotic treatment was small due to the high rate of spontaneous improvement (~69%). 8, 9 Studies using clinical diagnostic criteria tend to show no or minimal treatment benefit and higher spontaneous resolution (~80%).…”

mentioning

confidence: 99%

Amoxicillin for Acute Rhinosinusitis

Garbutt¹,

Banister²,

Spitznagel³

et al. 2012

JAMA

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Context Evidence to support antibiotic treatment for acute rhinosinusitis is scant, yet antibiotics are commonly used. Objective To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute rhinosinusitis. Design Randomized placebo-controlled trial Participants and Setting Adults with uncomplicated, acute rhinosinusitis were recruited from 10 community practices in Missouri between November 1st 2006 and May 1st 2009 Interventions Ten-day course of either amoxicillin (1500mg/day) or placebo administered in three doses/day. All patients received a 5-7-day supply of symptomatic treatments for pain, fever, cough and nasal congestion to use as needed. Main Outcome Measures The primary outcome was improvement in the disease-specific quality of life after 3–4 days of treatment assessed with the SNOT-16 (minimally important difference 0.5 on 0 to 3 scale). Secondary outcomes included the patients' retrospective assessment of change in sinus symptoms and functional status, recurrence or relapse, satisfaction with and adverse effects of treatment. Outcomes were assessed by telephone interview at Days 3, 7, 10 and 28. Results 166 adults (36% male, 78% Caucasian) were randomized to amoxicillin (85) or placebo (81); 92% concurrently used ≥1 symptomatic treatment (amoxicillin, 94%, placebo 90%, p=0.34). The mean change in SNOT-16 scores was not significantly different between groups on Day 3 (mean difference between groups 0.03, 95% CI −0.12 to 0.19) and Day 10, but differed at Day 7 favoring amoxicillin (mean difference between groups 0.19, 95% CI 0.024 to 0.35). At Day 7 more participants treated with amoxicillin reported symptom improvement (74% vs. 56%, p=0.0205; NNT = 6, 95% CI 3 to 34), with no difference at Day-3 or Day-10. No between group differences were found for any other secondary outcomes. No serious adverse events occurred. Conclusion Among patients with acute rhinosinusitis, a 10-day course of amoxicillin compared with placebo did not reduce symptoms at day 3 of treatment.

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confidence: 99%

Amoxicillin for Acute Rhinosinusitis

Garbutt¹,

Banister²,

Spitznagel³

et al. 2012

JAMA

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“…Additionally, IV antibiotics in our trial might have had better penetration than those in previous trials where oral antibiotics were administered post- rather than preirrigation. 45 -47 In another trial, 52 repeated irrigations proved successful even without the need for antibiotics.…”

Section: Discussionmentioning

confidence: 98%

“…These studies (Table 2) included up to 523 patients and demonstrated significant positive effects of repeated lavage; no more than 46% of patients and as few as 0 of 202 cases 33 required surgery. 32,33,[39][40][41][42][43][44] Subsequently, clinical trials reported a slight advantage of sinus irrigation over the traditional antibiotics without significant benefits over the newer generations of antibiotics [45][46][47] and surgical techniques; therefore, the use of sinus trephination waned and was reserved for identification of bacteria and bacteria-specific antibiotics. 7,48 Furthermore, repeated puncturing and trephination included risks, such as bleeding, contamination, pain, swelling of the cheek, and in rare cases, puncturing of the orbit or vasovagal responses.…”

Section: Discussionmentioning

confidence: 99%

Safety of a New Sinus Irrigation Device in Rhinosinusitis: A Pilot Study

et al. 2021

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Background: Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. Methods: The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. Results: The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events.

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Does This Patient Have Sinusitis?

Brett¹

1994

JAMA

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Treatment of Acute Maxillary Sinusitis

Cited by 73 publications

References 9 publications

Amoxicillin for Acute Rhinosinusitis

Amoxicillin for Acute Rhinosinusitis

Safety of a New Sinus Irrigation Device in Rhinosinusitis: A Pilot Study

Does This Patient Have Sinusitis?

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