Are antibiotics helpful for acute maxillary sinusitis?
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The inability of clinical criteria to accurately differentiate bacterial from viral disease makes routine use of antibiotics inappropriate for clinically diagnosed maxillary sinusitis (strength of recommendation [SOR]: C, based on inconsistent systematic reviews and randomized controlled trials). Antibiotics can provide symptomatic relief, best demonstrated in patients with bacterial maxillary sinusitis confirmed by computed tomography (CT) or sinus aspiration (SOR: A, based on 1 systematic review). However, this benefit does not persist in trials that better reflect general practice by using clinical diagnostic criteria (SOR: C, inconsistent studies). In trials showing improvement with antibiotics, symptoms decrease, at best, 2 to 3 days sooner than with placebo, and, regardless of treatment, at least two thirds of patients are improved in 14 days (SOR: A, based on multiple systematic reviews). No evidence suggests that antibiotics decrease complication rates. Newer broad-spectrum antibiotics are no better at relieving symptoms or improving cure rates than “firstline” agents such as amoxicillin (SOR: A, based on multiple randomized controlled trials).