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Giorgio Zanetti – One of the best experts on this subject based on the ideXlab platform.

  • Acute Rhinosinusitis
    PharmacoEconomics, 2004
    Co-Authors: Jean-blaise Wasserfallen, Françoise Livio, Giorgio Zanetti

    Abstract:

    Acute Rhinosinusitis is a common disease, in both children and adult patients, and happens most often in the setting of a viral infection with or without bacterial superinfection. Although spontaneous resolution is common, antibacterials are often prescribed and have a tremendous impact on costs, either directly or through the emergence of resistance in causative or colonising micro-organisms. The purpose of this work was to review published literature from 1989 to 2002 on antibacterial treatment in Acute Rhinosinusitis from a clinical and economical perspective. A relatively small number of studies have compared antibacterials with placebo and few have suggested that antibacterials are superior to placebo, except when a bacterial cause is established or in the presence of specific CT-scan findings. On the other hand, 58 randomised controlled trials were published between 1989 and 2002, that compared the relative efficacy of various antibacterials. Most of these studies had serious methodological flaws, and no single antibacterial proved superior to its comparators. Economic data are scarce and indicate cost of disease is high. Of the different treatment strategies assessed symptomatic treatment (patients being treated with antibacterials only if they failed to improve after 7 days) was the most cost-effective approach, compared with treating patients on the basis of specific clinical criteria, empirical treatment (all patients initially treated with antibacterials), or radiology-guided treatment. Cost effectiveness varied with disease prevalence. In conclusion, this pharmacoeconomic review of antibacterial use in Acute Rhinosinusitis shows the need for improvement in the quality of the studies feeding economic analyses, but suggests that huge financial interests are at stake. Savings achievable, by better targeting patients needing antibacterial treatment, could be substantial, and more practical and precise diagnostic procedures are clearly needed. Acute Rhinosinusitis is a typical example of a clinical dilemma in which good clinical practice must be balanced against imperfect information and patients’ individual interests balanced against society’s interest.

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  • Acute Rhinosinusitis : a pharmacoeconomic review of antibacterial use.
    PharmacoEconomics, 2004
    Co-Authors: Jean-blaise Wasserfallen, Françoise Livio, Giorgio Zanetti

    Abstract:

    Acute Rhinosinusitis is a common disease, in both children and adult patients, and happens most often in the setting of a viral infection with or without bacterial superinfection. Although spontaneous resolution is common, antibacterials are often prescribed and have a tremendous impact on costs, either directly or through the emergence of resistance in causative or colonising micro-organisms. The purpose of this work was to review published literature from 1989 to 2002 on antibacterial treatment in Acute Rhinosinusitis from a clinical and economical perspective. A relatively small number of studies have compared antibacterials with placebo and few have suggested that antibacterials are superior to placebo, except when a bacterial cause is established or in the presence of specific CT-scan findings. On the other hand, 58 randomised controlled trials were published between 1989 and 2002, that compared the relative efficacy of various antibacterials. Most of these studies had serious methodological flaws, and no single antibacterial proved superior to its comparators. Economic data are scarce and indicate cost of disease is high. Of the different treatment strategies assessed symptomatic treatment (patients being treated with antibacterials only if they failed to improve after 7 days) was the most cost-effective approach, compared with treating patients on the basis of specific clinical criteria, empirical treatment (all patients initially treated with antibacterials), or radiology-guided treatment. Cost effectiveness varied with disease prevalence. In conclusion, this pharmacoeconomic review of antibacterial use in Acute Rhinosinusitis shows the need for improvement in the quality of the studies feeding economic analyses, but suggests that huge financial interests are at stake. Savings achievable, by better targeting patients needing antibacterial treatment, could be substantial, and more practical and precise diagnostic procedures are clearly needed. Acute Rhinosinusitis is a typical example of a clinical dilemma in which good clinical practice must be balanced against imperfect information and patients’ individual interests balanced against society’s interest.

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Mieke L Van Driel – One of the best experts on this subject based on the ideXlab platform.

  • Antibiotics for Acute Rhinosinusitis in adults
    Cochrane Database of Systematic Reviews, 2018
    Co-Authors: Marieke B. Lemiengre, Mieke L Van Driel, Daniel Merenstein, Helena Liira, Marjukka Mäkelä, An De Sutter

    Abstract:

    Background: Acute Rhinosinusitis is an Acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of Acute Rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. We merged two Cochrane Reviews for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. Objectives: To assess the effects of antibiotics versus placebo or no treatment in adults with Acute Rhinosinusitis in ambulatory care settings. Search methods: We searched CENTRAL (2017, Issue 12), which contains the Cochrane Acute Respiratory Infections Group’s Specialised Register, MEDLINE (January 1950 to January 2018), Embase (January 1974 to January 2018), and two trials registers (January 2018). We also checked references from identified trials, systematic reviews, and relevant guidelines. Selection criteria: Randomised controlled trials of antibiotics versus placebo or no treatment in people with Rhinosinusitis-like signs or symptoms or sinusitis confirmed by imaging. Data collection and analysis: Two review authors independently extracted data about cure and side effects and assessed the risk of bias. We contacted trial authors for additional information as required. Main results: We included 15 trials involving 3057 participants. Of the 15 included trials, 10 appeared in our 2012 review, and five (631 participants) are legacy trials from merging two reviews. No new studies were included from searches for this update. Overall, risk of bias was low. Without antibiotics, 46% of participants with Rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Antibiotics can shorten time to cure, but only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; I; = 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; I; = 0%; 3 trials; moderate-quality evidence). Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial; moderate-quality evidence). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; I; = 0%; 3 trials; high-quality evidence). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; I; = 16%; 10 trials; high-quality evidence). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; I; = 21%; 12 trials; high-quality evidence). A disease-related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group). Authors’ conclusions: The potential benefit of antibiotics to treat Acute Rhinosinusitis diagnosed either clinically (low risk of bias, high-quality evidence) or confirmed by imaging (low to unclear risk of bias, moderate-quality evidence) is marginal and needs to be seen in the context of the risk of adverse effects. Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated Acute Rhinosinusitis. We could not draw conclusions about children, people with suppressed immune systems, and those with severe sinusitis, because these populations were not included in the available trials.

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  • antibiotics for clinically diagnosed Acute Rhinosinusitis in adults
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Marieke B. Lemiengre, James B. Young, Mieke L Van Driel, Daniel Merenstein, An De Sutter

    Abstract:

    In primary care settings, the diagnosis of Rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. To assess the effect of antibiotics in adults with clinically diagnosed Rhinosinusitis in primary care settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012). Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with Rhinosinusitis-like signs or symptoms. Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials. We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of Rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics. The potential benefit of antibiotics in the treatment of clinically diagnosed Acute Rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated Acute Rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials.

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R.p. Venekamp – One of the best experts on this subject based on the ideXlab platform.

  • Absence of evidence for enhanced benefit of antibiotic therapy on recurrent Acute Rhinosinusitis episodes: a systematic review of the evidence base
    Otolaryngology–Head and Neck Surgery, 2013
    Co-Authors: Nina M. Kaper, R.p. Venekamp, Wilko Grolman, Laura Breukel, Geert J. M. G. Van Der Heijden

    Abstract:

    ObjectiveTo systematically review the evidence base on the effectiveness of short-course antibiotic therapy in adult patients with a recurrent episode of Acute Rhinosinusitis as part of a disease pattern on severity and duration of symptoms and recurrences.Data SourcesPubMed, EMBASE, and the Cochrane Library.Review MethodsA comprehensive search was performed up to March 21, 2013. Articles reporting studies on the effects of short-course antibiotic therapy compared with placebo in patients with recurrent Acute Rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias.ResultsIn total, 3473 unique publications were retrieved, of which 30 were considered eligible based on title and abstract screening. In addition, 8 eligible articles were retrieved using cross-reference checking. Based on full-text evaluation, none of the retrieved 38 articles satisfied our predefined selection criteria. They did not compare antibiotic treatmen…

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  • Limited Evidence for Effects of Intranasal Corticosteroids on Symptom Relief for Recurrent Acute Rhinosinusitis
    Otolaryngology–Head and Neck Surgery, 2013
    Co-Authors: Juliette W. L. Van Loon, R.p. Venekamp, Alfred P. E. Sachs, Rochustina P. Van Harn, Nina M. Kaper, Geert J. M. G. Van Der Heijden

    Abstract:

    Objective. To systematically review the evidence base on the effectiveness of intranasal corticosteroids in adult patients with recurrent Acute Rhinosinusitis. Data Sources. Pubmed, EMBASE, and the Cochrane Library. Review Methods. A comprehensive search was performed up to March 20, 2013. Two reviewers independently screened publications on title and abstract. Design of selected studies was assessed on directness of evidence and risk of bias. For included studies, risk differences with 95% confidence inter- vals were extracted or recalculated. Results. Of 1850 unique records, 3 trials were included. Risk of bias was high and directness of evidence was low for 2 tri- als, the third trial had low risk of bias with moderate direct- ness of evidence. They found a statistical significant difference for the median number of days to clinical success (defined as patients’ report of symptoms to be cured or much improved) favoring intranasal corticosteroids (6 days) over placebo (9 days), while the difference in proportion of patients report- ing clinical success after 21 days of treatment was 20% favor- ing intranasal corticosteroids over placebo. Conclusion and Recommendation. The evidence for the benefit of intranasal corticosteroids on symptom relief in adult patients with recurrent Acute Rhinosinusitis is rather limited (ie, 3 trials are available; the best evidence is derived from 1 low risk of bias trial providing moderate directness of evidence that intranasal corticosteroids may speed up relief of symptoms in patients with recurrent Acute Rhinosinusitis). A large methodologically rigorous randomized trial in antibiotic-naive patients is needed to provide a more definite recommendation.

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  • Acute Rhinosinusitis and systemic corticosteroids
    Canadian Medical Association Journal, 2013
    Co-Authors: R.p. Venekamp

    Abstract:

    We sincerely thank Dr. Ukwaja[1][1] for his commentary on our CMAJ article.[2][2] To the best of our knowledge, no sign, symptom or test has been identified that can accurately differentiate viral from bacterial infection in patients with clinically diagnosed Acute Rhinosinusitis. Clinical practice

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