Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with acute sinusitis
Intervention: Short-course antibiotics
Comparison: Long-course antibiotics
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Cure or improvement (at the test of cure time point; 10-36 days' follow-up) | No statistically significant difference | High |
Cure or improvement (at the test of cure time point; 5 days vs. 10 days) | No statistically significant difference | High |
Cure or improvement (at the test of cure time point; beta-lactam antibiotics) | No statistically significant difference | High |
Relapse | No statistically significant difference | Low |
Relapse (5 days vs. 10 days) | No statistically significant difference | Low |
Relapse (beta-lactam antibiotics) | No statistically significant difference | Low |
Microbiological efficacy | No statistically significant difference | High |
Adverse events | No statistically significant difference | High |
Adverse events (5 days vs. 10 days) | Occurs more commonly with long-course antibiotics compared with short-course antibiotics (favours intervention) | Moderate |
Adverse events (beta-lactam antibiotics) | No statistically significant difference | Very Low |
Withdrawals due to adverse events | No statistically significant difference | Low |
Withdrawals due to adverse events (5 days vs. 10 days) | No statistically significant difference | Very Low |
Withdrawals due to adverse events (beta-lactam antibiotics) | No statistically significant difference | Low |
Recommendations as stated in the source guideline Consider no antibiotic prescription or a back-up antibiotic prescription, taking account of: Evidence suggests that antibiotics make little difference to how long symptoms last, or the proportion of people with improved symptoms Withholding antibiotics is unlikely to lead to complications Possible adverse effects, particularly diarrhoea and nausea Factors that might make a bacterial cause more likely (see guideline for more information on symptoms and signs). Additional information specific to length of treatment: The committee agreed that, when an antibiotic is appropriate, the shortest course that is likely to be effective should be prescribed. Based on evidence, their experience, and resistance data, the committee agreed that a 5-day course for all the recommended antibiotics was sufficient to treat acute sinusitis in adults and children. This takes into account the overall efficacy and safety evidence for antibiotics, and minimises the risk of resistance. Studies in the evidence review for specific antibiotics in acute sinusitis sometimes had longer course lengths than 5 days.
Note The first recommendation in this table refers to people presenting with symptoms for around 10 days or more with no improvement. See NICE guideline for separate recommendations for people with symptoms less than 10 days or those presenting at any time who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high risk of complications. No systematic reviews or RCTs in children comparing short and long courses of antibiotics were identified.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
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