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Br J Gen Pract. 1997 December; 47(425): 794–799.
PMCID: PMC1410064

The end of antibiotic treatment in adults with acute sinusitis-like complaints in general practice? A placebo-controlled double-blind randomized doxycycline trial.

Abstract

BACKGROUND: Acute sinusitis-like complaints are very common and are usually treated with antibiotics in spite of the lack of evidence for the effectiveness of antibiotic therapy and the increasing number of resistant strains. AIM: To assess the effectiveness of doxycycline in adults with acute sinusitis-like complaints in general practice. METHOD: The effects of doxycycline in a placebo-controlled, double-blind, randomized trial were assessed in adults consulting their general practitioner (GP) with complaints after a common cold or influenza, pain in the head when bending forward, purulent nasal discharge, predominantly unilateral maxillary pain, toothache, or pain when chewing. Primary outcome events were the resolution of facial pain and the resumption of daily activities. Treatment differences were assessed by means of Kaplan-Meier curves and hazard ratios. The follow-up period was 42 days. RESULTS: No significant difference was found in time to recover between the doxycycline-treated group and the placebo-treated group. However, the adjusted hazard ratio for the group receiving doxycycline was 1.17 (95% CI = 0.87-1.57) for the resolution of pain and 1.31 (95% CI = 0.96-1.78) for the resumption of daily activities. After 10 days, 85% of all patients reported improvement and 60% were completely cured. Side effects were reported by 17% of the doxycycline-treated group, with two patients withdrawing because of side effects. CONCLUSIONS: Data from this study indicate that doxycycline does not add to the effectiveness of decongestive nose drops and steam inhalation in treating acute sinusitis-like complaints in general practice adults.

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Selected References

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  • Berg O, Carenfelt C, Kronvall G. Bacteriology of maxillary sinusitis in relation to character of inflammation and prior treatment. Scand J Infect Dis. 1988;20(5):511–516. [PubMed]
  • Lindbaek M, Hjortdahl P, Johnsen UL. Randomised, double blind, placebo controlled trial of penicillin V and amoxycillin in treatment of acute sinus infections in adults. BMJ. 1996 Aug 10;313(7053):325–329. [PMC free article] [PubMed]
  • de Bock GH, Houwing-Duistermaat JJ, Springer MP, Kievit J, van Houwelingen JC. Sensitivity and specificity of diagnostic tests in acute maxillary sinusitis determined by maximum likelihood in the absence of an external standard. J Clin Epidemiol. 1994 Dec;47(12):1343–1352. [PubMed]
  • van Duijn NP, Brouwer HJ, Lamberts H. Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography. BMJ. 1992 Sep 19;305(6855):684–687. [PMC free article] [PubMed]
  • Lindbaek M, Hjortdahl P, Johnsen UL. Use of symptoms, signs, and blood tests to diagnose acute sinus infections in primary care: comparison with computed tomography. Fam Med. 1996 Mar;28(3):183–188. [PubMed]
  • Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute maxillary sinusitis in a general practice population. BMJ. 1995 Jul 22;311(6999):233–236. [PMC free article] [PubMed]
  • Gwaltney JM, Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med. 1994 Jan 6;330(1):25–30. [PubMed]
  • de Melker RA, Kuyvenhoven MM. Management of upper respiratory tract infection in Dutch general practice. Br J Gen Pract. 1991 Dec;41(353):504–507. [PMC free article] [PubMed]
  • Evans FO, Jr, Sydnor JB, Moore WE, Moore GR, Manwaring JL, Brill AH, Jackson RT, Hanna S, Skaar JS, Holdeman LV, et al. Sinusitis of the maxillary antrum. N Engl J Med. 1975 Oct 9;293(15):735–739. [PubMed]
  • Evans KL. Diagnosis and management of sinusitis. BMJ. 1994 Nov 26;309(6966):1415–1422. [PMC free article] [PubMed]
  • Kaiser L, Lew D, Hirschel B, Auckenthaler R, Morabia A, Heald A, Benedict P, Terrier F, Wunderli W, Matter L, et al. Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions. Lancet. 1996 Jun 1;347(9014):1507–1510. [PubMed]
  • Mainous AG, 3rd, Hueston WJ, Clark JR. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold. J Fam Pract. 1996 Apr;42(4):357–361. [PubMed]
  • Kuyvenhoven M, de Melker R, van der Velden K. Prescription of antibiotics and prescribers' characteristics. A study into prescription of antibiotics in upper respiratory tract infections in general practice. Fam Pract. 1993 Dec;10(4):366–370. [PubMed]
  • Agbim OG. A comparative trail of doxycycline ('Vibramycin') and ampicillin in the treatment of acute sinusitis. Curr Med Res Opin. 1974;2(5):291–294. [PubMed]
  • Bamberger DM. Antimicrobial treatment of sinusitis. Semin Respir Infect. 1991 Jun;6(2):77–84. [PubMed]
  • Kayser FH, Morenzoni G, Santanam P. The Second European Collaborative Study on the frequency of antimicrobial resistance in Haemophilus influenzae. Eur J Clin Microbiol Infect Dis. 1990 Nov;9(11):810–817. [PubMed]
  • Kennedy DW. First-line management of sinusitis: a national problem? Overview. Otolaryngol Head Neck Surg. 1990 Nov;103(5 ):847–854. [PubMed]
  • Jacoby GA, Archer GL. New mechanisms of bacterial resistance to antimicrobial agents. N Engl J Med. 1991 Feb 28;324(9):601–612. [PubMed]
  • Stalman W, van Essen GA, van der Graaf Y, de Melker RA. Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials. Fam Pract. 1997 Apr;14(2):124–129. [PubMed]
  • Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep;1(3):277–299. [PubMed]
  • Berg O, Carenfelt C. Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol. 1988 Mar-Apr;105(3-4):343–349. [PubMed]
  • Chalmers TC, Smith H, Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981 May;2(1):31–49. [PubMed]
  • van der Lei J, Duisterhout JS, Westerhof HP, van der Does E, Cromme PV, Boon WM, van Bemmel JH. The introduction of computer-based patient records in The Netherlands. Ann Intern Med. 1993 Nov 15;119(10):1036–1041. [PubMed]
  • Knottnerus JA, Leffers P. The influence of referral patterns on the characteristics of diagnostic tests. J Clin Epidemiol. 1992 Oct;45(10):1143–1154. [PubMed]
  • Rantanen T, Arvilommi H. Double-blind trial of doxicycline in acute maxillary sinusitis. A clinical and bacteriological study. Acta Otolaryngol. 1973 Jul;76(1):58–62. [PubMed]
  • van Buchem FL, Knottnerus JA, Schrijnemaekers VJ, Peeters MF. Primary-care-based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis. Lancet. 1997 Mar 8;349(9053):683–687. [PubMed]
  • Smith MB, Feldman W. Over-the-counter cold medications. A critical review of clinical trials between 1950 and 1991. JAMA. 1993 May 5;269(17):2258–2263. [PubMed]
  • Kharitonov SA, Yates D, Barnes PJ. Increased nitric oxide in exhaled air of normal human subjects with upper respiratory tract infections. Eur Respir J. 1995 Feb;8(2):295–297. [PubMed]
  • Tyrrell D, Barrow I, Arthur J. Local hyperthermia benefits natural and experimental common colds. BMJ. 1989 May 13;298(6683):1280–1283. [PMC free article] [PubMed]
  • Mann W, Jonas I. Untersuchungen zur Spontanheilung der Sinusitis maxillaris. HNO. 1981 Mar;29(3):92–94. [PubMed]
  • Stammberger H. Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg. 1986 Feb;94(2):143–147. [PubMed]

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