Medicine by the Numbers

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Antibiotics for Acute Rhinosinusitis in Adults


Am Fam Physician. 2019 Oct 1;100(7):online.


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1 in 17 achieved clinical cure at 7 to 14 days

1 in 8 experienced adverse effects from antibiotics



1 in 17 achieved clinical cure at 7 to 14 days

1 in 8 experienced adverse effects from antibiotics

Details for This Review

Study Population: Adults with suspected acute rhinosinusitis (symptoms for 30 days or fewer)

Efficacy End Points: Clinical cure (resolution or improvement of major symptoms)

Harm End Points: Adverse effects from antibiotic use

Narrative: Acute rhinosinusitis is a common condition encountered by clinicians in ambulatory and emergency department settings. It is characterized by inflammation of nasal passages and sinuses, resulting in purulent nasal discharge, sinus tenderness, and facial pain. Most cases are caused by a viral or self-limiting bacterial infection, neither of which require treatment with antibiotics.1 Despite longstanding guidelines that recommend limiting the use of antibiotics to a small subset of patients, most patients continue to be prescribed antibiotics.2

The Cochrane review examined data on benefits and harms associated with the use of antibiotics in adults with acute rhinosinusitis (symptoms for 30 days or fewer).3 The rate of clinical cure without antibiotics after one and two weeks was 46% and 64%, respectively. The definition of clinical cure varied depending on the study but was usually defined as resolution or improvement of major symptoms.

The Cochrane review categorized the participants into three groups: those with rhinosinusitis diagnosed clinically, radiographically, and by computed tomography (CT). The use of antibiotics was associated with a significant increase in the cure rate of clinically diagnosed rhinosinusitis (odds ratio [OR] = 1.25; 95% CI, 1.02 to 1.54; 5% absolute risk difference [ARD]; number needed to treat [NNT] = 19; high-quality evidence), radiographically diagnosed rhinosinusitis (OR = 1.57; 95% CI, 1.03 to 2.39; 10% ARD; NNT = 10; mode

Author disclosure: No relevant financial affiliations.

Copyright © 2019 MD Aware, LLC ( Used with permission.

This series is coordinated by Dean A. Seehusen, MD, MPH, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at


show all references

1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72–e112....

2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315(17):1864–1873.

3. Lemiengre MB, van Driel ML, Merenstein D, et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018;(9):CD006089.

4. American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: acute sinusitis. Accessed January 26, 2019.



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