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March 26, 2008

Antibiotics and Nasal Steroids for Acute Sinusitis

JAMA. 2008;299(12):1422-1423. doi:10.1001/jama.299.12.1422-b

To the Editor: A randomized, controlled trial conducted by Dr Williamson and colleagues1 found that amoxicillin and the intranasal steroid budesonide, whether used individually or together, were ineffective as treatments for acute maxillary sinusitis. I believe that the results of this study should be interpreted with caution.

First, budesonide was administered once a day at a dosage (200 μg) that is indicated for the treatment of allergic rhinitis and has been demonstrated effective for sinusitis only in children.2 In another study, mometasone furoate nasal spray, the only intranasal steroid investigated as both monotherapy and adjunctive therapy for rhinosinusitis, was given at 200 μg twice daily (double the indicated dosage for allergic rhinitis) to adolescents and adults with acute rhinosinusitis of at least 7 days' duration.3 At this dosage, mometasone furoate was significantly superior to both placebo and amoxicillin in improving the morning and afternoon major symptom score (the primary end point), whereas a 200-μg once daily dosage was significantly superior to placebo only. These results were reflected by significant reductions in inflammatory symptoms (eg, nasal congestion, rhinorrhea, and facial pain). Similar results were observed among patients receiving 200 to 400 μg of mometasone furoate twice daily as adjunctive therapy to an antibiotic.4