Amoxicillin for Acute Rhinosinusitis

Author: Michele Reed, PharmD

A recent randomized, placebo-controlled trial of adults with uncomplicated, acute rhinosinusitis was conducted to determine the incremental effect of amoxicillin treatment over symptomatic treatments for adults with acute rhinosinusitis.2

Study subjects (n = 166) were recruited from 10 community practices in Missouri between November 1, 2006, and May 1, 2009, and were randomized to receive either amoxicillin (1500 mg/ day) or placebo administered in 3 doses per day for a 10-day course. Patients also received symptomatic treatments for pain, fever, cough, and nasal congestion to use as needed. The primary end point of the study was 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).

Results showed that the mean change in Sinonasal Outcome Test-16 scores was not significantly different between groups on day 3 (decrease of 0.59 in the amoxicillin group and 0.54 in the control group; mean difference = 0.03 [95% CI, -0.12 to 0.19]). Additionally, there was no significant difference between groups on day 10 (mean difference = 0.01 [95% CI, -0.13 to 0.15]), but the groups differed at day 7, favoring amoxicillin (mean difference = 0.19 [95% CI, 0.024-0.35]). 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), whereas at day 7 more participants treated with amoxicillin reported symptom improvement (74% vs 56%, respectively; P = .02).

The authors concluded that among patients with acute rhinosinusitis, a 10-day course of amoxicillin, compared with placebo, did not reduce symptoms at day 3 of treatment.



Dr. Reed received her doctor of pharmacy degree from the University of the Sciences in Philadelphia, Pennsylvania, and currently works as a medical editor in the greater Philadelphia area.

References:

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2. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes [published online ahead of print March 26, 2012]. N Engl J Med. 2012;366(17):1567-1576.

3. Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G. Do physicians understand cancer screening statistics? a national survey of primary care physicians in the United States. Ann Intern Med. 2012;156(5):340-349.

4. Avery AJ, Rodgers S, Cantrill JA, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis [published online ahead of print February 21, 2012]. Lancet. 2012;379(9823):1310-1319.