Intranasal Corticosteroids in Management of Acute Sinusitis: A Systematic Review and Meta-Analysis

PURPOSE Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefi t.Intranasal corticosteroids might relieve symptoms; however, evidence for this benefi t is currently unclear.We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis. METHODSWe 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. RESULTSWe 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 signifi cant, 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 signifi cant benefi ts for facial pain and congestion.Subgroup analysis by time of reported outcomes showed a signifi cant benefi cial 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).Metaregression analysis of trials using different doses of mometasone furoate showed a signifi cant dose-response relationship (P = .02).CONCLUSIONS Intranasal corticosteroids offer a small therapeutic benefi t 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.