Efficacy and safety of azithromycin in treating sinusitis patients: a systematic review and meta-analysis of randomized controlled trails

Background: Sinusitis is an inflammation of the paranasal sinuses and is commonly treated with antibiotics. The widely used antibiotics for this condition are macrolides, especially azithromycin. However, its effectiveness and side effects are still questionable compared to the other antibiotics. Therefore, this systematic review and meta-analysis assessed the efficacy and safety profile of azithromycin in sinusitis. Methods: We adhered to PRISMA guidelines. A comprehensive literature review was performed to find out about randomized controlled trials concerning azithromycin compared with other antibiotics in sinusitis treatment. The main outcomes were the cure rate, pathogen eradication rate, and relapse rate. The secondary outcome was the adverse events rate. Results: Fourteen trials were considered for review, with a sample size of 4201 patients. The pooled analysis for included studies indicated a high cure rate (70.86%) and pathogen eradication rate (74.55%), as well as a low relapse rate (4.82%) and adverse events rate (14.33%) for azithromycin in treating sinusitis patients. The quality of the included studies was considered to be moderate. In a meta-analysis, azithromycin demonstrated superiority in the cure rate to other antibiotics in the study but no difference in pathogen eradication rate, relapse rate, or adverse events rate. Conclusion: Our results showed promising efficacy and safety of azithromycin in the management of sinusitis patients. However, moderate heterogeneity among studies and a 14.33% rate of adverse effects, primarily gastrointestinal, indicate the importance of individualized treatment decisions. Further research is needed to address variability and optimize its clinical application.