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Antibiotics for clinically diagnosed acute rhinosinusitis: an individual patient data meta-analysis (IPDMA) of randomised controlled trials (RCTs)

English title Antibiotics for clinically diagnosed acute rhinosinusitis: an individual patient data meta-analysis (IPDMA) of randomised controlled trials (RCTs)
Applicant Bucher Heiner C.
Number 111770
Funding scheme Project funding
Research institution Institut für klinische Epidemiologie Universitätsspital Basel
Institution of higher education University of Basel - BS
Main discipline Medical Statistics
Start/End 01.04.2006 - 31.03.2007
Approved amount 34'916.00
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Keywords (4)

antibiotics; randomised controlled trial; acute rhinosinusitis; sinusitis

Lay Summary (English)

Lead
Lay summary
Background: Primary care physicians continue to over-prescribe antibiotics for acute rhinosinusitis because it is difficult to distinguish between viral and bacterial sinus infection. We undertook an individual patient data meta-analysis of randomised trials to see if common signs and symptoms are able to identify a patient subgroup that benefits from antibiotics.Methods: Individual patient data from 2547 adults in 9 trials were checked and re-analysed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needing antibiotic treatment (NNT) to cure one additional patient.Findings: 15 patients with rhinosinusitis-like complaints must be treated with antibiotics before an additional patient is cured (95% CI NNT(benefit) 7 to NNT(harm) 190). Patients with purulent discharge in the pharynx take longer to cure, but it is still necessary to treat 8 patients with this sign before one additional patient is cured (95% CI NNT(benefit) 4 to NNT(harm) 47). Older patients, those reported symptom for longer and those reporting more severe symptoms also take longer to cure but are no more likely to benefit from antibiotics than other patients.Interpretation: Antibiotics offer little benefit for patients with rhinosinusitis-like complaints and common clinical signs and symptoms cannot identify patients for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for more than 7 to 10 days. Antibiotics are needed if signs suggest a serious complication.
Direct link to Lay Summary Last update: 21.02.2013

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Associated projects

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140997 Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care - a Pragmatic Randomized Controlled Trial 01.06.2012 Project funding
122455 Procalcitonin or C reactive protein versus guidelines for patient management of acute respiratory tract infections in primary care: A randomized controlled pragmatic trial 01.08.2010 Project funding

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