1 / 16

Acute Bacterial Rhinosinusitis

Acute Bacterial Rhinosinusitis. Brief Background. Typically follows viral infection Dx is by clinical manifestations Streptococcus pneumoniae , Haemophilus influenzae and, to a lesser degree , Moraxella catarrhalis. Treatment. Medical therapy

gareth
Download Presentation

Acute Bacterial Rhinosinusitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Acute BacterialRhinosinusitis

  2. Brief Background • Typically follows viral infection • Dx is by clinical manifestations • Streptococcus pneumoniae, Haemophilusinfluenzae and, to a lesser degree, Moraxellacatarrhalis

  3. Treatment • Medical therapy • Fluoroquinolones: highly ranked among antibacterials • Surgery • For recurrent or persistent rhinosinusitis

  4. The Evidence • “Fluoroquinolonescompared with β-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials” • Screened 191 trials • Used 11 trials

  5. The Evidence • Validity • Meta-analysis ofRCTs comparing the effectiveness and safety of fluoroquinolonesand β-lactams in acute bacterial sinusitis • Inclusion criteria • Diagnosis based on clinical criteria • RCTs in other languages excluded • RCTs comparing fluoroquinolones with beta lactams

  6. Outcomes of the Meta-Analysis • Primary comparison • Respiratory fluoroquinolones vs. beta lactams • Secondary comparison • All fluoroquinolones vs. beta lactams • Effectiveness and safety outcomes • intention to treat population • clinically evaluable population • Bacteriologically evaluable population

  7. Assessing Methodology of the RCTs • reporting of adequate randomization procedures • allocation concealment • masking of the intervention • reporting of study withdrawals • reporting of patient crossovers between treatment arms • reporting of violation of the inclusion criteria

  8. Data Analysis • calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) • assessed publication bias

  9. Results • Primary effectiveness analysis • extent of clinical cure and improvement did not differ between fluoroquinolones and β-lactams (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.85–1.39) at the test-of-cure assessment, which varied from 10 to 31 days after the start of treatment

  10. Results • Fluoroquinolones were associated with an increased chance of clinical success among the clinically evaluable patients in all of the randomized controlled trials (OR 1.29, 95% CI 1.03–1.63) and in 4 blinded randomized controlled trials (OR 1.45, 95% CI 1.05–2.00)

  11. Results • no statistically significant difference between fluoroquinolones and amoxicillin–clavulanate (OR 1.24, 95% CI 0.93–1.65).

  12. Results • Eradication or presumed eradication of the pathogens isolated before treatment was more likely with fluoroquinolone treatment than with β-lactam treatment (OR 2.11, 95% CI 1.09–4.08)

  13. Results • adverse events did not differ between treatments (OR 1.17, 95% CI 0.86–1.59) • In 2 blinded RCTs: more adverse events occurred with fluoroquinoloneuse than with β-lactamuse

  14. Applicability • Treatment is feasible since both are easily available • Benefit vs harm • Adverse events did not greatly differ between the two • Fluoroquinolones: diarrhea • Beta lactams: nausea • propensity for more adverse events in association with fluoroquinolone use was observed in sensitivity and exploratory analyses

  15. Main Findings • respiratory fluoroquinolones did not prove superior to β- lactams for the treatment of acute bacterial sinusitis in terms of clinical cure or total adverse events • marginal benefit of fluoroquinolones over β-lactams in terms of rapidity of symptom resolution • respiratory fluoroquinolones as a valuable therapeutic option for cases resistant to β-lactams

  16. Main Findings • use of respiratory fluoroquinolones as first-line therapy in the vast majority of patients with bacterial sinusitis, in whom the condition often has a benign clinical course, is not supported by the available evidence.

More Related