The inflammation or infection of the paranasal sinuses with 20 million acute cases and 31 million cases of chronic sinusitis in the U.S.

The most common diagnosis for which antibiotics are prescribed in the US, and accounts for 15-21% of all antibiotic prescriptions for adults.

Acute, symptoms last up to 4 weeks and in chronic sinusitis symptoms may last up to 12 weeks.

A high percentage of viral upper respiratory infections become secondarily infected with bacteria.

Recurrent-defined as four or more episodes a year of at least 7 days duration.

Headache or pain related to sinuses described associated dull and pressure like, usually bilateral and periorbital and worse in the morning from nasal sinus and turbinate congestion which improves during the day.

Pain associated with nasal obstruction, congestion and persists for days without nausea, vomiting or visual disturbances.

Site and severity of pain not correlated to extent or location of mucosal disease.

Mild to moderate sinusitis is defined as sinusitis without high temperature, severe pain or tenderness over the involved sinuses.

Meta-analyses of randomized controlled trials comparing the effects of antibiotics with placebo for acute sinusitis disclose that at 7-15 days after beginning treatment cure or improvement was higher in antibiotic group compared to placebo group, but the differences are small (Smith SR et al).

In the above meta-analyses rates of cure for improvement in placebo treated patients range from 64-80%, compared with 71-90% in antibiotic managed patients, and the difference in cure or improvement rates between placebo and the antibiotic group range from 7-14% higher in the antibiotic group.

Meta-analyses reporting the adverse effects of antibiotic treatment team acute sinusitis suggest that adverse effects, primarily diarrhea, were 80% more common in the antibiotic groups compared with placebo, and 30-74% of patients have adverse effects when treated with antibiotics in this population.

Meta-analyses demonstrate high cure rates in patients with acute sinusitis not treated with antibiotics, and antibiotic treatment provides a small benefit over placebo but is associated with a marked increase in the rate of adverse events.

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