Corticosteroids for acute rhinosinusitis

Acute rhinosinusitis is a common reason for consultations in general practice, with typically 50 cases seen by a general practitioner annually. Traditionally, acute rhinosinusitis has been regarded as a bacterial infection of the paranasal sinuses. Therefore, numerous randomised controlled trials have been performed to determine the clinical effectiveness of oral antibiotics in patients with this condition. Summarising the results of these studies, we can conclude that antibiotics should not be advocated even if symptoms persist for seven days. Nowadays, acute inflammation of the paranasal mucosa due to infectious and non-infectious causes is increasingly considered as the predominant path in the causation of symptoms of acute rhinosinusitis. As a consequence, (intranasal) corticosteroids could be a treatment option in clinically diagnosed acute rhinosinusitis. In this thesis, we aimed to evaluate the effectiveness of corticosteroids in clinically diagnosed acute rhinosinusitis. Chapter 2 describes the consultation and prescription rates for adult patients with ARS in general practice between 2000 and 2009. The main focus of this study is to determine whether a change in daily practice could be observed before and after the introduction of the revised guideline on ARS in 2005 which recommends to restrict the use of antibiotics and intranasal corticosteroids in this condition. In chapter 3 we perform systematic reviews of the literature on the use of corticosteroids in ARS. We investigate the efficacy of intranasal corticosteroids as a monotherapy (chapter 3.1) and the effectiveness of systemic corticosteroids (chapter 3.2). Chapter 4 describes the results of a double blind, placebo-controlled, randomised clinical trial to assess the effectiveness of systemic corticosteroids (prednisolone 30mg daily for seven days) in adult patients who visited their general practitioner with clinically diagnosed acute rhinosinusitis. In chapter 5, we examine whether subgroup analyses were reported on a relative or absolute scale in randomised controlled trials that were published in five major general medical journals in 2010. In chapter 6 we discuss the treatment options for clinically diagnosed acute rhinosinusitis in a broader perspective. The thesis ends with a summary of the main findings, including recommendations for both clinical practice and future research