CMAJ • March 25, 2008; 178 (7). doi:10.1503/cmaj.071157.
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Research

Fluoroquinolones compared with β-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials

Drosos E. Karageorgopoulos, MD, Konstantina P. Giannopoulou, MD, Alexandros P. Grammatikos, MD MSc, George Dimopoulos, MD and Matthew E. Falagas, MD DSc

From the Alfa Institute of Biomedical Sciences (AIBS) (all authors), Athens, Greece; the Department of Medicine (Grammatikos), Gennimatas General Hospital, Thessaloniki, Greece; the Intensive Care Unit (Dimopoulos), Attikon University Hospital, Athens, Greece; and the Department of Medicine (Falagas), Tufts University School of Medicine, Boston, Mass.

Correspondence to: Dr. Matthew E. Falagas, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos St., 151 23 Marousi, Greece; fax 30 210 683-9605; m.falagas{at}aibs.gr

Background: The presumed superiority of newer fluoroquinolones for the treatment of acute bacterial sinusitis is based on laboratory data but has not yet been established on clinical grounds.

Methods: We performed a meta-analysis of randomized controlled trials comparing the effectiveness and safety of fluoroquinolones and β-lactams in acute bacterial sinusitis.

Results: We identified 8 randomized controlled trials investigating the newer "respiratory" fluoroquinolones moxifloxacin, levofloxacin and gatifloxacin. In the primary effectiveness analysis involving 2133 intention-to-treat patients from 5 randomized controlled trials, the extent of clinical cure and improvement did not differ between fluoroquinolones and β-lactams (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.85–1.39) at the test-of-cure assessment, which varied from 10 to 31 days after the start of treatment. Fluoroquinolones were associated with an increased chance of clinical success among the clinically evaluable patients in all of the randomized controlled trials (OR 1.29, 95% CI 1.03–1.63) and in 4 blinded randomized controlled trials (OR 1.45, 95% CI 1.05–2.00). There was no statistically significant difference between fluoroquinolones and amoxicillin–clavulanate (OR 1.24, 95% CI 0.93–1.65). Eradication or presumed eradication of the pathogens isolated before treatment was more likely with fluoroquinolone treatment than with β-lactam treatment (OR 2.11, 95% CI 1.09–4.08). In the primary safety analysis, adverse events did not differ between treatments (OR 1.17, 95% CI 0.86–1.59). However, more adverse events occurred with fluoroquinolone use than with β-lactam use in 2 blinded randomized controlled trials. The associations described here were generally consistent when we included 3 additional studies involving other fluoroquinolones (ciprofloxacin and sparfloxacin) in the analysis.

Interpretation: In the treatment of acute bacterial sinusitis, newer fluoroquinolones conferred no benefit over β-lactam antibiotics. The use of fluoroquinolones as first-line therapy cannot be endorsed.


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Can. Med. Assoc. J. 2008 178: 865-866. [Full Text] [PDF]



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N. Le Saux MD
The treatment of acute bacterial sinusitis: No change is good medicine
Can. Med. Assoc. J., March 25, 2008; 178(7): 865 - 866.
[Full Text] [PDF]