The Efficacy And Safety Of Broad-Spectrum Antibiotics For Rhinosinusitis: A Systematic Review For Outpatient Patients

Abstract

The debate surrounding antibiotic use in acute rhinosinusitis is ongoing, with 85% of cases being viral and 40% being chronic. Antibiotics are more effective than placebo for purulent nasal discharge and discolored mucus, and trials comparing antibiotics with placebo and the right antibiotics are needed to reduce unnecessary prescriptions while ensuring efficacy. Acute rhinosinusitis is one of the most common infections in the United States, accounting for 2% of ambulatory care visits and costing approximately $500 million for treatment with antibiotics. A recent report from the National Ambulatory Medical Care Survey showed an increased monotherapy antibiotic use for rhinosinusitis from 31% in 1990-1992 to 84% in 1999. Ninety percent of the antibiotics used were broad-spectrum ones. Subacute rhinosinusitis occurs in 0.5-2% of cases. 85% of the 200,000 sinus surgical procedures in the US are due to acute rhinosinusitis. This review aims to address controversies on antibiotic use in acute rhinosinusitis by focusing on high-quality studies to comprehensively assess the efficacy and safety of broad-spectrum antibiotics in the treatment of acute rhinosinusitis. A thorough search of multiple reputable databases will be conducted, extracting data from each study regarding the study design, sample size, duration of treatment, follow-up period, primary and secondary outcomes, and any adverse events. The Cochrane Risk of Bias Tool will be used to assess the methodological quality of the selected studies, minimizing potential bias. Sensitivity analyses will be conducted to evaluate the robustness of the findings and explore potential sources of heterogeneity among the included studies. A comprehensive discussion of the limitations and implications of the findings will help provide a balanced view of the current evidence and guide future research in this area. By elucidating the controversies surrounding antibiotic use in acute rhinosinusitis, this systematic review aims to contribute to the existing literature and promote evidence-based decision-making in clinical practice.