No place for antibiotics for acute rhinosinusitis in adults

No place for antibiotics for acute rhinosinusitis in adults

Brian McAvoy
Clinical question

Compared with placebo or no treatment, how effective are antibiotics in adults with acute rhinosinusitis in ambulatory care settings?

Bottom line

Without antibiotics, almost half of all participants were cured after 1 week, and 2 out of 3 were cured after 14 days. Five (diagnosis based on symptoms described to a doctor) to 11 (diagnosis confirmed by x‐ray) more people per 100 were cured faster with antibiotics. A computed tomography scan could better predict who would benefit from antibiotics, but routine use would cause health problems related to radiation exposure. Ten more people per 100 were relieved faster of thick, yellow discharge from the nose with antibiotics compared with placebo or no treatment. Thirteen more people per 100 experienced side effects (mostly gastrointestinal) with antibiotics compared with placebo or no treatment. Compared with people who initially started antibiotics, 5 more people per 100 in the placebo or no treatment group had to start antibiotics because their condition worsened. Serious complications (eg, brain abscess) were rare.


Two Cochrane Reviews were merged for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. We could not draw conclusions about children, people with suppressed immune systems and those with severe sinusitis, because these populations were not included in the available trials.


Diagnosis of acute rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.

Cochrane Systematic Review

Lemiengre MB et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Reviews, 2018, Issue 9. Art. No.: CD006089.DOI: 10.1002/14651858. CD006089.pub5. This review contains 15 studies involving 3057 participants.