February 22, 2012
Volume 7 - Issue 8           

DynaMed Weekly Update

For the week ending February 17, 2012  

Last week 432 articles were evaluated via DynaMed's Systematic Literature Surveillance and 196 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Amoxicillin for Acute Rhinosinusitis Does Not Improve Symptoms at 3 Days But Reduces Likelihood of Symptoms at 7 Days


Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) and the Centers for Disease Control and Prevention (CDC) recommend deferring antibiotic treatment for acute bacterial rhinosinusitis for at least 7 days after diagnosis and limiting initial management to symptomatic relief. If the decision is made to treat with antibiotics, amoxicillin is the first-line therapy recommended for most adults (Otolaryngol Head Neck Surg 2007 Sep;137(3 Suppl):S1, Ann Intern Med 2001 Mar 20;134(6):479). A new randomized trial evaluated the efficacy of amoxicillin in 166 adults with acute sinusitis treated according to these guidelines.


Patients aged 18-70 years meeting the CDC diagnostic criteria for acute bacterial rhinosinusitis with symptoms for 7-28 days were randomized to amoxicillin 500 mg vs. placebo orally 3 times daily for 10 days. All patients had moderate to very severe symptoms with mean duration of 11 days. A 5-7 day supply of symptomatic treatments was given to all patients. The primary outcome was change in disease-specific quality of life measured by the SNOT-16 score (Sinonasal Outcome Test-16). The SNOT-16 score rates the severity of 16 sinus-related symptoms on a 0-3 scale, with a minimally important difference of 0.5 points. Patients also rated their overall symptoms on a scale of 0-6, ranging from no symptoms to feeling "a lot worse."


On day 3 of treatment there were no significant differences in mean reduction in SNOT-16 score (0.59 vs. 0.54) or self-reported symptom improvement (symptoms rated as "a lot better" or no symptoms in 37% vs. 34%) (level 1 [likely reliable] evidence). On day 7, the mean SNOT-16 score was statistically improved for the amoxicillin group (mean reduction 1.06 vs. 0.86, p = 0.02) but this difference did not reach the threshold of clinical importance. However, the amoxicillin group did show clinically meaningful improvement in the proportion of patients rating themselves as a lot better or without symptoms (74% vs. 56%, p = 0.02, NNT 6). At 10 days there were no significant differences in symptoms. There were no significant differences in adverse events, days of work missed, relapse or recurrence, or satisfaction with treatment at any time point (JAMA 2012 Feb 15;307(7):685).


For more information, see the Acute sinusitis topic in DynaMed.



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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: February 22, 2012 
Expiration Date: February 22, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

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In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

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Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
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AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


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Program ID 1102071Y.

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