Table 3.
Summary of the evidence for ‘efficacy of systemic steroids in acute rhinosinusitis in adults’
| Study | Year | LOE (1a to 5) | Study design | Study groups | Clinical end-point efficacy | Conclusion |
|---|---|---|---|---|---|---|
| Cannoni et al. | 1990 | 1b | RCT |
1. Adults with (sub)acute, non-allergic sinusitis with antibiotics and prednisolone 40–60 mg/day for 7 days 2. Adults with (sub)acute, non-allergic sinusitis with antibiotics and NSAID for 7 days |
1. Therapeutic success defined as combination of resolution of pain and absence of nasal discharge clinically and endoscopically at day 7 | Beneficial effect of prednisolone in combination with antibiotics |
| Gehanno et al. | 2000 | 1b | RCT |
1. Adults with acute sinusitis treated with antibiotics and methylprednisolone 8 mg; 3×/day for 5 day 2. Adults with acute sinusitis treated with antibiotics and placebo for 5 days |
1. Clinical recovery on d 14 2. Course of symptoms on day 4 3. Symptoms and radiological signs on day 30 |
Significant pain relief in combination with antibiotics compared to antibiotics in monotherapy, no additional effect on nasal discharge |
| Klossek et al. | 2004 | 1b | RCT |
1. Adults with acute maxillary sinusitis treated with antibiotics and prednisone 0.8–1.2 mg/kg/day for 3 days 2. Adults with acute maxillary sinusitis treated with antibiotics and placebo for 3 days |
1. Difference in VAS for pain at baseline and day 3 2. Differences in VAS for nasal obstruction 3. Time to pain relief 4. Administration of paracetamol 5. Global subjective effect of treatment on day 3 6. Global subjective effect of treatment on days 10–12 |
Benefit of short course treatment of prednisone in combination with antibiotics vs. antibiotics with placebo |
| Ratau et al. | 2004 | 1b | RCT |
1. Adults with acute sinusitis treated with antibiotics and betamethasone 1 mg/day for 5 days 2. Adults with acute sinusitis treated with antibiotics and placebo for 5 days |
1. Improvement of symptoms between day 0 and day 6 2. Percentage of participants with physical signs present or absent on day 0 and day 6 3. Number of paracetamol tablets taken |
Benefit of steroids treatment in combination with antibiotics vs. antibiotics with placebo |
| Venekamp et al. | 2012 | 1b | RCT |
1. Adults with acute sinusitis treated with prednisolone 30 mg/day for 7 days 2. Adults with acute sinusitis treated with placebo for 7 days |
1. Resolution of facial pain/pressure at day 7 2. Resolution of other clinically relevant symptoms on day 7 3. Time to resolution of total symptoms 4. Median duration of symptoms 5. Quality of life 6. Resumption of daily activities |
No clinically beneficial effects of systemic corticosteroid monotherapy |
RCT randomized controlled trial, MP methylprednisolone, NSAID non-steroidal anti-inflammatory drug