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Is It Time To Stop Treating Acute Sinusitis?

Posted Feb 14 2012 8:55pm

From the pages of JAMA comes this startling clinical trial :

A randomized, placebo-controlled trial of adults with uncomplicated, acute rhinosinusitis [who] were recruited from 10 community practices in Missouri between November 1, 2006, and May 1, 2009 … [Subjects received a] ten-day course of either amoxicillin (1500 mg/d) or placebo administered in 3 doses per day … There was no statistically significant difference in reported symptom improvement at day 3 (37% for amoxicillin group vs 34% for control group; p=.67) or at day 10 (78% vs 80%, respectively; p=.71).

To be fair, I did leave out that outcomes favored the amoxicillin group at day 7. And I also left out that the validated instrument they used to gauge symptoms was called the “Sinonasal Outcome Test-16″, or “SNOT-16″

Ahem.

But still – I’m willing to wager good money that if you asked 100 primary care providers, ENT specialists, ID doctors, and patients whether they thought antibiotics helped relieve symptoms of acute sinusitis, 90% would answer “yes.”

And 99% would would want it for themselves.

Critics of this study might quibble about the inclusion criteria, or the fairly large number of screened study subjects who were not enrolled, or the selection of amoxicillin over amoxicillin-clavulanate. What, no Moraxella catarrhalis coverage?

Regardless, this trials reminds us that, even though it’s hard to believe, the human species did survive many eons before the discovery of antibiotics in the 20th century, and that furthermore, most of the common community-acquired infections resolve spontaneously.

Time will tell whether the results from the study will influence practice guidelines, patient perception, and — most importantly — clinical practice.

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