Nasal Steroids Not Much Help in Acute Sinusitis (CME/CE)

MedPageToday, 2012

Also, another British group previously reported that provided significant relief from acute sinusitis symptoms.
Though widely used in the treatment of upper respiratory infections, intranasal steroids have minimal high-level supporting evidence.
A recent review of four randomized, controlled trials showed a small effect of topical steroids on sinusitis symptoms ( Cochrane Database Syst Rev 2009; (4): CD005149).
However, the trials had exhibited substantial heterogeneity, and the review did not include the aforementioned trial that found no benefit from antibiotics or intranasal steroids.
In an effort to clarify the conflicting results, Hayward and colleagues performed a systematic review to identify randomized controlled trials of intranasal steroids for acute sinusitis reported to February 2011.
The trials involved a cumulative total of 2,495 patients treated in outpatient otorhinolaryngology clinics, emergency departments, and general practice clinics (four from the U.S.
The youngest patients in the studies ranged from ages 12 to 18, except for one study that included only patients 15 and younger.
Three trials evaluated mometasone furoate (Nasonex), two evaluated budesonide, and one evaluated fluticasone propionate (Flonase).
In five of the trials, the primary outcome was improvement or resolution of symptoms within 14 to 21 days.
After exclusion of two lower-quality studies, a significant difference in favor of intranasal steroids persisted (RD 0.07, P =0.02).
Three studies evaluated outcomes after 14 to 15 days and showed no significant difference from placebo (RD 0.05, P =0.13).