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Table 3 Summary of the evidence for ‘efficacy of systemic steroids in acute rhinosinusitis in adults’

From: Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

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
  1. RCT randomized controlled trial, MP methylprednisolone, NSAID non-steroidal anti-inflammatory drug