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Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis

BMJ 1998; 317 doi: (Published 05 September 1998) Cite this as: BMJ 1998;317:632
  1. Sarah D de Ferranti, research associatea,
  2. John P A Ioannidis, research fellowb,
  3. Joseph Lau (joseph.lau{at}, associate professora,
  4. William V Anninger, research assistanta,
  5. Michael Barza, professorb
  1. aDivision of Clinical Care Research, Department of Medicine, New England Medical Center, 750 Washington Street, Boston, MA 02111, USA
  2. bDivision of Geographic Medicine and Infectious Diseases, Tupper Research Institute, Department of Medicine, New England Medical Center, Boston
  1. Correspondence to: Dr Lau


    Objectives: To examine whether antibiotics are indicated in treating uncomplicated acute sinusitis and, if so, whether newer and more expensive antibiotics with broad spectra of antimicrobial activity are more effective than amoxycillin or folate inhibitors.

    Design: Meta-analysis of randomised trials.

    Setting: Outpatient clinics.

    Subjects: 2717 patients with acute sinusitis or acute exacerbation of chronic sinusitis from 27 trials.

    Interventions: Any antibiotic versus placebo; amoxycillin or folate inhibitors versus newer, more expensive antibiotics.

    Main outcome measurements: Clinical failures and cures.

    Results: Compared with placebo, antibiotics decreased the incidence of clinical failures by half (risk ratio 0.54 (95% confidence interval 0.37 to 0.79)). Risk of clinical failure among 1553 randomised patients was not meaningfully decreased with more expensive antibiotics as compared with amoxycillin (risk ratio 0.86 (0.62 to 1.19); risk difference 0.9 fewer failures per 100 patients (1.4 more failures to 3.1 fewer failures per 100 patients)). The results were similar for other antibiotics versus folate inhibitors (risk ratio 1.01 (0.52 to 1.97)), but data were sparse (n=410) and of low quality.

    Conclusions: Amoxycillin and folate inhibitors are essentially as effective as more expensive antibiotics for the initial treatment of uncomplicated acute sinusitis. Small differences in efficacy may exist, but are unlikely to be clinically important.

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