| Sumario: | QUESTION: In adults with acute maxillary sinusitis, which antibiotics lead to higher clinical cure rates? Data sources: Studies were identified by searching Medline and EMBASE/Excerpta Medica (to October 1998) with the heading sinusitis and terms for randomised controlled trials, scanning bibliographies of relevant articles, and contacting pharmaceutical companies and experts in the field. Study selection: Studies were selected if they were randomised controlled trials (RCTs) that compared an antibiotic with placebo or another class of antibiotic in >/=30 patients who were >/= 18 years of age and had a history consistent with acute maxillary sinusitis confirmed by radiography or aspiration. Data extraction: 2 or more reviewers independently extracted data on stud characteristics: interventions; study duration: length of follow up; cointerventions; compliance; and clinical, bacteriological, radiographic, and adverse event outcomes. Main results: 32 RCTs (7330 patients) with 34 comparisons met the inclusion criteria. Treatment duration ranged from 3-15 days. Penicillin V led to an increase in clinical cure rate (table). No difference in clinical cure rate was seen for amoxicillin compared with control in 2 heterogeneous RCTs. Newer non-penicillin antibiotics compared with penicillin V or amoxicillin (8 RCTs), or macrolide or cephalosporin compared with amoxicillin-clavulanate (8 RCTs) showed no difference in clinical cure rates. 5 RCTs comparing tetracyclines with a heterogeneous mix of antibiotics could not be meta-analsed. Dropouts from adverse effects were fewer for macrolide or cephalosporin than for amoxicillin-clavulanate (9 RCTs) (table). Conclusion: In adults with acute maxillary sinusitis, penicillin V is better than placebo and equal to non-penicillins for achieving clinical cure. [Original article accession number: 2000029493 (research, systematic review, tables/charts)]
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