Acute Community-Acquired Bacterial Sinusitis: The Value of Antimicrobial Treatment and the Natural History

• Published in: Clinical infectious diseases Vol. 38; no. 2; pp. 227 - 233
• Main Authors: Gwaltney, Jack M., Wiesinger, Barbara A., Patrie, James T.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-01-2004; University of Chicago Press
• Subjects: Acute Disease; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobials; Bacterial Infections - drug therapy; Bacterial Infections - ethnology; Biological and medical sciences; Clinical trials; Community-Acquired Infections - drug therapy; Community-Acquired Infections - ethnology; Diseases; Experimentation; Humans; Imaging; Major Articles; Maxillary sinus; Medical sciences; Natural History; Non tumoral diseases; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Patient Compliance; Placebos; Randomized Controlled Trials as Topic; Sinuses; Sinusitis; Sinusitis - drug therapy; Sinusitis - ethnology; Treatment Outcome; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Human; Nose disease; Rhinitis; Acute; Rate; Error; Duration; Recipient; Case history; Antimicrobial agent; Standards; Sinusitis; Infection; Validity; Need; Community acquired infection; Treatment; Bacteriosis; ENT disease; Paranasal sinus disease; Diagnosis; Bibliographic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/380641

Two areas of investigation were reviewed: (1) placebo-controlled trials of antimicrobial treatment involving patients with a clinical diagnosis of acute community-acquired bacterial sinusitis (ACABS) for whom pre- and posttherapy sinus aspirate cultures were not performed, and (2) uncontrolled trials of antimicrobial treatment involving patients with ACABS for whom pre- and posttherapy sinus aspirate cultures were performed. The clinical diagnostic criteria in the controlled trials were not correlated with sinus aspirate culture results and, thus, were of questionable validity. Most of the populations probably included patients with viral rhinosinusitis. In 10 uncontrolled studies, the posttreatment, weighted, pooled mean bacterial resolution rate (± standard error) at 7–10 days, based on sinus aspirate culture results, was 91% ± 10%. In 9 controlled trials, the weighted pooled mean rate of clinical improvement (± standard deviation) at 7–14 days for placebo recipients was 52% ± 18%. In 1 controlled trial in which diagnosis was based on duration of unimproved illness, 57% of placebo recipients and 85.5% of treated patients were healthy or had improved by day 10. Additional studies of ACABS are needed.