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Are fluoroquinolones better than beta-lactams for acute bacterial sinusitis?

No. Fluoroquinolones have no benefit over beta-lactams for acute bacterial rhinosinusitis (ABRS). The more important and relevant questions are whether we can distinguish ABRS from viral sinusitis (not very well) and whether antibiotics are needed at all (probably not for most patients). If you decide to prescribe an antibiotic because of severity of illness or duration of symptoms, a beta-lactam will work as well as a fluoroquinolone.

Karageorgopoulos DE, Giannopoulou KP, Grammatikos AP, Dimopoulos G, Falagas ME. Fluoroquinolones compared with beta-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials. CMAJ. 2008;178:845-854.

Level of evidence

1a: Systematic reviews (with homogeneity) of randomized controlled trials

The authors identified 11 studies that compared a fluoroquinolone with a beta-lactam for ABRS. Study quality was mixed: 5 studies were open label, 5 did not adequately describe randomization, 8 did not describe allocation concealment, and 4 did not describe patient withdrawals. The fluoroquinolones studied were moxifloxacin (4 studies), levofloxacin (3 studies), gatifloxacin (1 study), ciprofloxacin (2 studies), and sparfloxacin (1 study). The most common comparison drugs were cefuroxime axetil (5 studies) and amoxicillin clavulanate (5 studies). The dose of the comparator drug was adequate; 8 studies required computed tomography or radiographic abnormalities for inclusion in addition to typical symptoms of ABRS.

No benefit to "respiratory" fiuoroquinolones

Using intent-to-treat analysis, the authors found no benefit to so-called "respiratory" fluoroquinolones (defined as fluoroquinolones with enhanced activity against Streptococcus pneumoniae that are recommended for the treatment of ABRS) compared with beta-lactams regarding clinical success (odds ratio [OR]=1.09; 95% CI, 0.85-1.39). If all "clinically evaluable" patients (ie, per protocol analysis) were included, fluoroquinolones showed a slight benefit (OR=1.29; 95% CI, 1.03-1.63).

Interestingly, the benefit was similar for the other fluoroquinolones (ciprofloxacin and sparfloxacin), which are supposed to have limited activity against S pneumoniae, one of the bacterial pathogens that cause ABRS.

STUDY DETAILS

Design

Meta-analysis (randomized controlled trials)

Funding

Unknown/not stated

Allocation

Uncertain

Setting

Outpatient (any)

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Article Details
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Title Annotation:InfoPOEMS[R]: Patient Oriented Evidence that Matters
Publication:Journal of Family Practice
Geographic Code:1USA
Date:Sep 1, 2008
Words:346
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