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Meta-Analysis
. 2012 May-Jun;10(3):241-9.
doi: 10.1370/afm.1338.

Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis

Gail Hayward  1 , Carl Heneghan, Rafael Perera, Matthew Thompson
Affiliations
Meta-Analysis

Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis

Gail Hayward et al. Ann Fam Med. 2012 May-Jun.

Abstract

Purpose: Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefit. Intranasal corticosteroids might relieve symptoms; however, evidence for this benefit is currently unclear. We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and Centre for Reviews and Dissemination databases until February 2011 for studies comparing intranasal corticosteroids with placebo in children or adults having clinical symptoms and signs of acute sinusitis or rhinosinusitis in ambulatory settings. We excluded chronic/allergic sinusitis. Two authors independently extracted data and assessed the studies' methodologic quality.

Results: We included 6 studies having a total of 2,495 patients. In 5 studies, antibiotics were prescribed in addition to corticosteroids or placebo. Intranasal corticosteroids resulted in a significant, small increase in resolution of or improvement in symptoms at days 14 to 21 (risk difference [RD] = 0.08; 95% CI, 0.03-0.13). Analysis of individual symptom scores revealed most consistently significant benefits for facial pain and congestion. Subgroup analysis by time of reported outcomes showed a significant beneficial effect at 21 days (RD = 0.11; 95% CI, 0.06-0.17), but not at 14 to 15 days (RD = 0.05; 95% CI, -0.01 to 0.11). Meta-regression analysis of trials using different doses of mometasone furoate showed a significant dose-response relationship (P=.02).

Conclusions: Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration. Further trials are needed in antibiotic-naïve patients.

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Figures

Figure 1
Figure 1
Flow diagram of search results.
Figure 2
Figure 2
Effect of intranasal steroids on resolution of symptoms of acute sinusitis at (A) 14 to 15 days and (B) 21 days. INCS=intranasal steroid.
Figure 2
Figure 2
Effect of intranasal steroids on resolution of symptoms of acute sinusitis at (A) 14 to 15 days and (B) 21 days. INCS=intranasal steroid.
Figure 3
Figure 3
Dose-response relationship of mometasone furoate and likelihood of symptom resolution.
See this image and copyright information in PMC

Comment in

References

    1. Lethbridge-Cejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. adults: National Health Interview Survey, 2002. Vital Health Stat 10. 2004;July(222):1–151 - PubMed
    1. Ashworth M, Charlton J, Ballard K, Latinovic R, Gulliford M. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995–2000. Br J Gen Pract. 2005;55(517):603–608 - PMC - PubMed
    1. Dosh SA, Hickner JM, Mainous AG, III, Ebell MH; Upper Peninsula Research Network Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis. An UPRNet study. J Fam Pract. 2000;49(5):407–414 - PubMed
    1. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008;(2): CD000243. - PubMed
    1. Rosenfeld RM, Singer M, Jones S. Systematic review of antimicrobial therapy in patients with acute rhinosinusitis. Otolaryngol Head Neck Surg. 2007;137(3 Suppl):S32–S45 - PubMed

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