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Antibiotics and Nasal Steroids for Acute Sinusitis
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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 . . . [Full Text of this Article]
Eli O. Meltzer, MD
eomeltzer@aol.com
Allergy and Asthma Medical Group and Research Center
San Diego, California
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JAMA. 2007;298(21):2487-2496.
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