Efficacy and side effects of antibiotics in the treatment of acute rhinosinusitis: a systematic review

Abstract

Acute rhinosinusitis (ARS) is one of the most common diagnoses for which an antibiotic is prescribed. Although the usage of antibiotics in the treatment of mild, moderate or uncomplicated ARS is not recommended by most international guidelines, overuse of antibiotics is still an alarming problem among patients and healthcare practitioners. We thus sought to review the evidence available through a systematic review of the existing literature on antibiotic usage in ARS. A search of the PubMed database was conducted for studies on antibiotic and placebo usage in the treatment of ARS. A total of 31 random control trials (RCT) reporting the clinical efficacy of treating ARS and side effects of using cefuroxime axetil, telithromycin, amoxicillin/potassium clavulanate, levofloxacin, moxifloxacin and clarithromycin were included in the review. Among them, 9 studies were performed double-blinded with placebo controls. The results showed that while antibiotics are more efficacious than placebos in the treatment of ARS, the risks of potential side effects need to be weighed against the potential benefit that antibiotics give to the patient. This is especially pertinent as usage of the placebo has shown to be almost as efficacious as using the antibiotic therapy, and also much safer. The usage of antibiotics in ARS is widespread and there seems to be only slight added benefit in the usage of antibiotics over placebo in the treatment of ARS. Hence, larger scale studies should be done in the future to confirm the results of these studies.