TY  - JOUR
T1  - Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: A randomized controlled trial
AU  - Williamson IG, Rumsby K, Benge S, et al
Y1  - 2007/12/05
N1  - 10.1001/jama.298.21.2487
JO  - JAMA
SP  - 2487
EP  - 2496
VL  - 298
IS  - 21
N2  - Context 
                  Acute sinusitis is a common clinical problem that usually results in a prescription for antibiotics but the role of antibiotics is debated. Anti-inflammatory drugs such as topical steroids may be beneficial but are underresearched.Objective 
                  To determine the effectiveness of amoxicillin and topical budesonide in acute maxillary sinusitis.Design, Setting, and Patients 
                  A double-blind, randomized, placebo-controlled factorial trial of 240 adults (aged ≥16 years) with acute nonrecurrent sinusitis (had ≥2 diagnostic criteria: purulent rhinorrhea with unilateral predominance, local pain with unilateral predominance, purulent rhinorrhea bilateral, presence of pus in the nasal cavity) at 58 family practices (74 family physicians) between November 2001 and November 2005. Patients were randomized to 1 of 4 treatment groups: antibiotic and nasal steroid; placebo antibiotic and nasal steroid; antibiotic and placebo nasal steroid; placebo antibiotic and placebo nasal steroid.Intervention 
                  A dose of 500 mg of amoxicillin 3 times per day for 7 days and 200 μg of budesonide in each nostril once per day for 10 days.Main Outcome Measures 
                  Proportion clinically cured at day 10 using patient symptom diaries and the duration and severity of symptoms.Results 
                  The proportions of patients with symptoms lasting 10 or more days were 29 of 100 (29%) for amoxicillin vs 36 of 107 (33.6%) for no amoxicillin (adjusted odds ratio, 0.99; 95% confidence interval, 0.57-1.73). The proportions of patients with symptoms lasting 10 or more days were 32 of 102 (31.4%) for topical budesonide vs 33 of 105 (31.4%) for no budesonide (adjusted odds ratio, 0.93; 95% confidence interval, 0.54-1.62). Secondary analysis suggested that nasal steroids were significantly more effective in patients with less severe symptoms at baseline.Conclusion 
                  Neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the primary care setting.Trial Registration 
                  isrctn.org Identifier: ISRCTN60825437
SN  - 0098-7484
M3  - doi: 10.1001/jama.298.21.2487
UR  - http://dx.doi.org/10.1001/jama.298.21.2487
ER  -