acute bacterial rhinosinusitis n.
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Acute Bacterial Rhinosinusitis. Brief Background. Typically follows viral infection Dx is by clinical manifestations Streptococcus pneumoniae , Haemophilus influenzae and, to a lesser degree , Moraxella catarrhalis. Treatment. Medical therapy

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brief background
Brief Background
  • Typically follows viral infection
  • Dx is by clinical manifestations
  • Streptococcus pneumoniae, Haemophilusinfluenzae and, to a lesser degree, Moraxellacatarrhalis
treatment
Treatment
  • Medical therapy
    • Fluoroquinolones: highly ranked among antibacterials
  • Surgery
    • For recurrent or persistent rhinosinusitis
the evidence
The Evidence
  • “Fluoroquinolonescompared with β-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials”
    • Screened 191 trials
    • Used 11 trials
the evidence1
The Evidence
  • Validity
    • Meta-analysis ofRCTs comparing the effectiveness and safety of fluoroquinolonesand β-lactams in acute bacterial sinusitis
    • Inclusion criteria
      • Diagnosis based on clinical criteria
      • RCTs in other languages excluded
      • RCTs comparing fluoroquinolones with beta lactams
outcomes of the meta analysis
Outcomes of the Meta-Analysis
  • Primary comparison
    • Respiratory fluoroquinolones vs. beta lactams
  • Secondary comparison
    • All fluoroquinolones vs. beta lactams
  • Effectiveness and safety outcomes
    • intention to treat population
    • clinically evaluable population
    • Bacteriologically evaluable population
assessing methodology of the rcts
Assessing Methodology of the RCTs
  • reporting of adequate randomization procedures
  • allocation concealment
  • masking of the intervention
  • reporting of study withdrawals
  • reporting of patient crossovers between treatment arms
  • reporting of violation of the inclusion criteria
data analysis
Data Analysis
  • calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs)
  • assessed publication bias
results
Results
  • Primary effectiveness analysis
    • extent of clinical cure and improvement did not differ between fluoroquinolones and β-lactams (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.85–1.39) at the test-of-cure assessment, which varied from 10 to 31 days after the start of treatment
results1
Results
  • Fluoroquinolones were associated with an increased chance of clinical success among the clinically evaluable patients in all of the randomized controlled trials (OR 1.29, 95% CI 1.03–1.63) and in 4 blinded randomized controlled trials (OR 1.45, 95% CI 1.05–2.00)
results2
Results
  • no statistically significant difference between fluoroquinolones and amoxicillin–clavulanate (OR 1.24, 95% CI 0.93–1.65).
results3
Results
  • Eradication or presumed eradication of the pathogens isolated before treatment was more likely with fluoroquinolone treatment than with β-lactam treatment (OR 2.11, 95% CI 1.09–4.08)
results4
Results
  • adverse events did not differ between treatments (OR 1.17, 95% CI 0.86–1.59)
  • In 2 blinded RCTs: more adverse events occurred with fluoroquinoloneuse than with β-lactamuse
applicability
Applicability
  • Treatment is feasible since both are easily available
  • Benefit vs harm
    • Adverse events did not greatly differ between the two
      • Fluoroquinolones: diarrhea
      • Beta lactams: nausea
    • propensity for more adverse events in association with fluoroquinolone use was observed in sensitivity and exploratory analyses
main findings
Main Findings
  • respiratory fluoroquinolones did not prove superior to β- lactams for the treatment of acute bacterial sinusitis in terms of clinical cure or total adverse events
  • marginal benefit of fluoroquinolones over β-lactams in terms of rapidity of symptom resolution
  • respiratory fluoroquinolones as a valuable therapeutic option for cases resistant to β-lactams
main findings1
Main Findings
  • use of respiratory fluoroquinolones as first-line therapy in the vast majority of patients with bacterial sinusitis, in whom the condition often has a benign clinical course, is not supported by the available evidence.