Article Title: Prophylactic Antibiotic Therapy for Fractures of the Maxillary Sinus

Journal Title: Ear, Nose, and Throat Journal

Publication Year: 2015

Author(s): Schmidt R., et al.

Study Description: Acute sinusitis has been linked to be a complication of maxillary sinus fractures. This study employed 50 patients who presented with a maxillary sinus fracture. Participants were prospectively randomized to received a 3 day course of antibiotics (Augmentin or Levofloxacin) or a nasal saline spray. After a 3 day minimum, participants were evaluated for the development of sinusitis. To assess for acute sinusitis. The Rhinosinusitis Trask Force of the American Academy of Otolaryngology-Head and Neck Surgery was used. Patients who had 1 major criteria or more than 2 minor criteria were deemed as having symptoms that suggest acute sinusitis. This study aimed to demonstrate the high incidence of sinusitis following maxillary sinus fracture and to evaluate the efficacy of prophylactic antibiotics to prevent sinusitis after injury.

Outcomes: The major outcome studied was the incidence of acute sinusitis. 31 patients completed the follow up period (17 in abx group and 14 in control group). After 3 days, 95.23% of the fractured sinuses in the antibiotic group and 88.23% of the fractured sinuses in the control group showed signs/symptoms suggestive of acute sinusitis. Only 1 patient in the antibiotic group and 2 in the control group showed no evidence of sinusitis.

Conclusion: A 3 day course of antibiotics was not superior to nasal saline spray in the prevention of signs/symptoms of acute sinusitis s/p maxillary sinus fractures from blunt trauma. The routine use of antibiotics in cases of blunt trauma is not acutely recommended.

Limitations:

1. Limited number of patients enrolled in trial – 50 patients were enrolled and only 31 completed it
2. Patients were not blinded to their study group
3. Data collectors were sometimes not blinded to patient’s study group, introducing bias

Clinical Applicability:

This study can help guide clinical practice by helping to determine whether the standard of care should continue to be to prescribe antibiotics for the prevention of sinusitis after maxillary facial fractures. The 3 day course of antibiotics was found to be generally well tolerated, however there was an increased incidence of vomiting in the treatment group. The use of antibiotics can cause unwanted adverse effects, along with contributing to antimicrobial resistance. This topic can use larger based studies with proper blinding to further determine the applicability of antibiotics in these cases.

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