I was intrigued by the abstract of the article by Bucher et al1 about the failure of antibiotics over placebo in acute rhinosinusitis. As I read the article I became confused over the patient population the authors were describing. I assume these were patients who started with classic signs of upper respiratory tract infection (URTI) such as rhinorrhea, sore throat, and perhaps lymphadenopathy and cough, but whose prominent feature was the presence of acute rhinosinusitis. It is implied that these patients were afebrile, although this information is not included. Nor was there any information about time of onset of the URTI to development of the sinusitis or other symptoms such as sore throat, nasal congestion, or cough. When I first looked at the data, I thought the authors were referring to patients who came in with no signs of URTI other than the sinusitis, and I'm still unsure which of these scenarios they are describing. Are they patients who started with typical URTI symptoms or did they present with only sinusitis? If these are patients with acute rhinosinusitis without other URTI symptoms, I do not know how to interpret this study, since I hardly ever see patients with acute rhinosinusitis who did not start out as having URTI. I work at a student health center and see a lot of sinusitis, which is virtually all viral, occurring in the course of URTI. I also see patients with chronic or recurrent sinusitis who get acute exacerbations. We have a high rate of allergic rhinitis in this area, which is a factor in many of the chronic cases. I was pleased to see that the antibiotic treatment seemed to have no beneficial effect on these patients, since it will help to convince physicians that most sinusitis in primary care is viral and part of a URTI and not a separate infection.
Melvyn G. Weinberg. Clarification of Patient Population in Sinusitis Article. Arch Intern Med. 2004;164(5):568. doi:10.1001/archinte.164.5.568-a