A meta-analysis 1 based on individual patient data included primary care studies with a clinical diagnosis of acute sinusitis comparing an antibiotic or a placebo. The study aimed to find out whether treatment effect with antibiotics was associated with certain symptoms of sinusitis. The symptom severity at baseline using symptom scores was analyzed from five trials. Patients reporting severe symptoms took longer to cure, but they were no more likely to benefit from treatment than other patients.
For other patient-reported symptoms - a previous common cold (or two stages of illness), pain on bending, unilateral face pain, pain in the teeth, and purulent nasal discharge - estimates were not sufficiently precise to draw any conclusion about their prognostic value other than that these symptoms might not be reliable enough to be of any real use.
In each trial, physicians were asked to do rhinoscopy with a rhinoscope or (in one trial) an otoscope. Although no firm conclusion could be drawn about the prognostic value of purulent nasal discharge, patients with purulent discharge in the pharynx took longer to cure and were more likely to benefit from treatment than other patients. The findings also suggested that treatment might offer additional benefit for patients with a higher temperature. The mean NNT for 10 000 simulated new patients with purulent discharge in the pharynx was 8 (95% CI NNT[benefit] 4 to NNT[harm] 47). This result was obtained from an analysis of only 1 269 patients in five trials (32% had purulent discharge in the pharynx). However, the multiplicative effect of purulent nasal discharge on the OR for cure was only slightly higher in these trials (1.18, 95% CI 0.73 to 1.92) than in all trials.
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