Antibiotics and Nasal Steroids Don’t Improve Acute Sinusitis

Patient-perceived sinusitis is responsible for 25 million office visits per year in the U.S. Despite that the diagnosis is confirmed infrequently and that many cases are viral, antibiotic prescribing rates vary from 67% to 90% in the U.S. and western Europe. In a double-blind, randomized, placebo-controlled trial, researchers evaluated the efficacy of amoxicillin and nasal budesonide in 240 adults (>16 years) who presented to 58 family practices in the U.K. during a 4-year period with acute nonrecurrent sinusitis (defined as presence of at least 2 diagnostic criteria: purulent rhinorrhea with unilateral predominance, local pain with unilateral predominance, purulent rhinorrhea bilaterally, or pus in the nasal cavity). Patients received amoxicillin (500 mg three times per day for 7 days) plus nasal budesonide (200 μg once per day in each nostril for 10 days), or each agent with corresponding placebo, or only placebo.

The proportion of patients who were clinically cured at 10 days and the duration and severity of symptoms did not differ significantly among the groups receiving either of the active treatments, both active treatments, or no active treatment.