For routine, office-based diagnoses of acute sinusitis, we’ve seen that antibiotics are unlikely to be beneficial. The other theory behind treatment is attenuation of the inflammatory response, promoting sinus drainage. Intranasal steroid sprays have inconclusive data. This is a trial of systemic steroids, theorizing that intranasal steroids suffer from inadequate tissue penetration.
There are a lot of issues with this trial. Whether it’s clinically significant or not, the 30mg/day dose of prednisolone is below the typically used doses of 50mg or 60mg. There were 54 treatment locations and 68 family physicians involved in this study over a 2 1/2 year period – and only managed to enroll 185 patients. For a problem “frequently encountered” in primary care, it’s a little hard to have confidence there aren’t biases present with enrollment.
The authors followed many different clinical outcomes, as well as the SNOT-20 score, at several different time points, and the easiest way to sum it up is to say there are probably no clinically relevant differences between groups. The trends nearly all favored prednisolone, but the absolute differences in outcomes provided NNT between 10 and 33. A larger trial might have detected a statistically significant benefit to steroids – or it might not – but most enrolled patients had symptom improvement, regardless.
“Systemic corticosteroid monotherapy for clinically diagnosed acute rhinosinusitis: a randomized controlled trial”
www.ncbi.nlm.nih.gov/pubmed/22872770