Nasal Steroids, Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Acute Sinusitis
Daniel Merenstein
Summary
Sinus infections (also called acute rhinosinusitis or ARS) affect about 15% of adults each year, and are one of the top reasons people receive antibiotics in outpatient settings. Since most sinus infections are caused by viruses, many patients who take antibiotics for this condition do not actually benefit. Even though this has decreased over recent years, 70% of people are still prescribed them after a visit for ARS. Our goal is to better understand which patients truly benefit from antibiotics and which other treatment options can help people with sinus infections.
Description
One in seven adults are diagnosed with acute sinus infections (also known as rhinosinusitis or ARS) every year in the United States, for an annual total of 30 million office visits. The majority of physician-diagnosed, acute sinus infections in outpatient setting are caused by viral infection, but antibiotics are prescribed in over 70% of these visits--without significant benefits to patients compared to placebo. Most ARS cases resolve without antibiotics; however, some patients do benefit from antibiotics. Previous research suggests that individuals with an elevated c-reactive protein level,…
Eligibility
- Age range
- 18–75 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. 18-75 years old; AND are experiencing either: 2. "persistent" symptoms or signs compatible with ARS or sinus infection lasting for 1-21 days without any evidence of clinical improvement (Symptoms include facial pain or pressure, facial congestion or fullness, nasal obstruction, nasal discharge, no or reduced sense of smell, fever ≤39°C or 102°F, headache, bad smelling breath, fatigue, ear pain or pressure, and dental pain); OR 3. onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical v…
Interventions
- Drugamoxicillin/clavulanate potassium
Amoxicillin/clavulanate, oral, 875mg/125mg twice daily for 7 days
- DrugPlacebo
Placebo for amoxicillin/clavulanate, oral, twice daily for 7 days
- DrugBudesonide nasal spray
Budesonide nasal spray, 32 mcg per spray, 2 sprays per nostril, once per day
Locations (7)
- University of California, Los AngelesLos Angeles, California
- Georgetown University Medical CenterWashington D.C., District of Columbia
- MedStar Health Research InstituteHyattsville, Maryland
- Penn State College of MedicineHershey, Pennsylvania
- Virginia Commonwealth UniversityRichmond, Virginia
- University of WashingtonSeattle, Washington