August 15, 2012

Corticosteroids Not That Effective for Acute Sinusitis

Utrecht, The Netherlands—Acute sinusitis can be a painful condition, and patients often are insistent on leaving their doctor’s office with a prescription. Increasingly, that prescription is for oral corticosteroids to reduce the discomfort caused by inflammation.

The only problem, according to a recent randomized, controlled trial, is that systemic corticosteroids show no clinical benefit in treating the condition. Corticosteroids were slightly superior in decreasing pain and other symptoms over 7 days, but those differences were statistically insufficient, according to the study published recently in the Canadian Medical Association Journal.

Antibiotics are only recommended for sinusitis when their usefulness is confirmed by diagnostic tests such as computed tomography scan.

Researchers from University Medical Centre Utrecht in The Netherlands conducted a randomized, double-blind controlled trial involving 174 adults with clinically diagnosed acute rhinosinusitis. One group of 88 patients was administered 30 mg/day of prednisolone for a week, while the other group of 86 received placebo.

In the prednisolone group, 55 of 88 patients (62.5%) reported that their facial pain or pressure had resolved by Day 7, versus 48 of 86 (55.8%) in the placebo group. The duration of total symptoms, including runny nose, postnasal discharge, nasal congestion, cough, and facial pain, were cut short by 2 days in the prednisolone group. The authors note that those outcomes were not clinically significant and that patients in both groups were able to resume daily activities at school or work on the same timetable.

“We found no clinically relevant effect of systemic corticosteroid monotherapy among patients with clinically diagnosed, uncomplicated acute rhinosinusitis,” the authors write. “There is no rationale for the use of corticosteroids in the broad population of patients with clinically diagnosed acute rhinosinusitis. Future studies should focus on identifying subgroups of patients who may benefit from intranasal or systemic corticosteroid treatment.”

The Dutch researchers say they advocate symptomatic treatment instead, and other recent research offers support for that conclusion.

A study published earlier this year in the Annals of Family Medicine found only a slight improvement in sinusitis with the use of intranasal corticosteroids.

U.S. Pharmacist Social Connect