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The "Comment" section of the article by Bucher et al¹ is disappointing because the authors only discuss findings that support their own. "Three placebo-controlled, randomized trials (all somewhat smaller than the present study) have evaluated different antibiotics in general practice for the treatment of acute rhinosinusitis."¹ The references cited do not include the largest trial,² with more than 300 patients compared with the 247 patients in the trial by Bucher et al, using amoxicillin and clavulanate potassium (co-amoxiclav) in a double-blind design. This trial generated the hypothesis that patients with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis in their secretions might profit from antibiotic treatment. This hypothesis was then tested in a second trial.³ This trial is commented on by Bucher et al¹: "they all showed no difference in improvement of symptoms or cure rates under treatment with antibiotics." Compare this comment with what Kaiser et al² . . . [Full Text of this Article]

Laurent Kaiser, MD; Bernard Hirschel, MD
Geneva, Switzerland

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