A Cochrane review [Abstract] 1 included 5 studies with a total of 1193 adult patients. Acute sinusitis was defined clinically in all trials. In addition, 3 trials (n=966) performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. Two trials were performed in an outpatient setting (n=227). All participants received oral antibiotics and were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in 4 trials and NSAIDs in one trial). The studies provided data on the effectiveness of oral corticosteroids up to Day 14, and their effects thereafter is unclear. In all trials participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than the control group (at Days 3 to 7: RR 1.3, 95% CI 1.1 to 1.6; risk difference [RD] 17%, 6% to 29% and at Days 4 to 14: RR 1.2, 95% CI 1.0 to 1.5, RD 14%, 1% to 27%). An analysis of the trials with placebo showed similar results but with a lesser effect size (Days 3 to 7: RR 1.2, 95% CI 1.1 to 1.3, RD 11%, 4% to 17% and Days 4 to 14: RR 1.1, 95% CI 1.0 to 1.2, RD 8%, 2% to 13%). No data was identified on the long-term effects of oral corticosteroids, such as effects on recurrence rates. Reported side effects of oral corticosteroids were limited and mild.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment).
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