Amoxicillin for Acute Rhinosinusitis A Randomized Controlled Trial Garbutt JM, Banister C, Spitznagel E, Piccirillo JF. JAMA 2012;307(7): Prof. Soo Youn Moon / R3 Min Hye Lee

Introduction Acute rhinosinusitis  common disease  significant morbidity  lost time from work  treatment costs Clinical benefit vs Antibiotic resistance  Antibiotics for sinusitis : 1/5 in the United States Objective : To determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with clinically diagnosed acute rhinosinusitis.

Methods Randomized, placebo-controlled trial 10 community practices in Missouri November 1, 2006 ~ May 1, 2009 Inclusion criteriaExclusion criteria Aged 18 to 70 yearsallergy to penicillin or amoxicillin History of maxillary pain or tenderness in the face or teeth Prior antibiotic treatment within 4 weeks purulent nasal secretionscomplications of sinusitis symptoms for7 days or more and 28 days or less that were not improving or worsening Comorbidity that may impair their immune response symptoms lasting for less than 7 days that had significantly worsened after initial improvement cystic fibrosis required an antibiotic for a concurrent condition pregnant symptoms as very mild or mild

Methods Ten-day course of either amoxicillin (1500 mg/d) or placebo administered in 3 doses per day 5- to 7-day supply of symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed Primary outcome : improvement in disease specific quality of life after 3 to 4 days of treatment assessed with the Sinonasal Outcome Test-16 (minimally important difference of 0.5 units on a 0-3 scale) Secondary outcomes : patient’s retrospective assessment of change in sinus symptoms and functional status, recurrence or relapse, and satisfaction with and adverse effects of treatment Outcomes : assessed by telephone interview at days 3, 7, 10, and 28.

Results

Conclusions Uncomplicated acute rhinosinusitis : treatment with amoxicillin for 10 days offers little clinical benefit for most patients.  Avoid routine antibiotic treatment.