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Steroids backed for sinusitis

GPs have been advised to consider prescribing intranasal steroids as an alternative to antibiotics for acute sinusitis after a key review found clear clinical benefits for their use, writes Lilian Anekwe.

Patients treated with intra-nasal steroids were more than 7 per cent more likely to have resolution of their symptoms than those given placebo, the Cochrane review found.Improvements were greatest with high doses of intranasal steroids. Patients given mome-tason furoate 400mcg were 6 per cent more likely to see an improvement in their symptoms than those given the 200mcg dose. No significant adverse events were reported from steroid treatment.The review concluded: 'For acute sinusitis, current evidence is limited, but supports use of intranasal steroids as mono-therapy or adjuvant therapy to antibiotics. Clinicians should weigh the modest but clinically important benefits against possible minor adverse events.'Researchers examined four studies of 1,943 patients with acute sinusitis who were prescribed intranasal steroids for either 15 or 21 days.Dr Anca Zalmanovici, leader of the review and attending family physician at the Rabin Medical Centre in Petach Tikva, Israel, said: 'There have been suggestions that intranasal steroids may relieve symptoms and hasten recovery in acute sinusitis because of their anti-inflammatory properties.'The results suggest there may be a modest effect with steroids in the resolution or improvement of symptoms.'Dr Michael Moore, a GP in Salisbury, Wiltshire, and a researcher on treatment of respiratory infections at the University of Southampton, said GPs often faced difficulties deciding on treatments.'The majority of infections are viral and only the minority are bacterial. But as there is no reliable diagnostic test available in primary care, a huge number of people are given antibiotics even though we know they only have a limited effect.'Dr Ian Williamson, a GP in Southampton who has conducted research on the treatment of sinusitis, said steroids might be an effective alternative to antibiotics – but only in some groups of patients.'Topical steroids probably are going to be beneficial in some people – maybe for milder cases of acute sinusitis, or earlier in the disease process.'

When steroids may be given

• Mild cases of acute sinusitis• Early infections• Cases of recurrent sinusitis• Those with history of allergies

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