Ces "réponses" étaient tellement peu convaincantes, ressemblant à des :
"vous avez raison, peut-être, mais quand même, vous êtes sûr ?" ou "mhouais, peut-être. Mais je vais continuer comme j'ai toujours fait, on ne sait jamais"
que j'ai été relire l'article original.
Je comprends mieux maintenant pourquoi cet article a eu des réactions.
Il s'agit d'une très grosse et très solide étude démontrant qu'un sein des patients de ville ayant une sinusite ou une rhino-sinusite, il n'y avait aucun sous-groupe identifiable à qui donner des antibiotiques était efficace...
Bref, si vous avez une sinusite cela ne sert strictement à rien de prendre des antibiotiques. Même quand cela "traine" plus de 10 jours.
Mode non scientifique ON/
Qui est-ce que cela fait plus râler :
-les industriels, option : "ce sont des salauds qui se foutent de notre santé, tout ce qu'ils veulent c'est notre argent
-la relation médecin-malade, option : "l'un veut garder son patient, l'autre veut absolument prendre "quelque chose" pour guérir..."
Mode non scientifique OFF/
Lancet. 2008 Mar 15;371(9616):908-14.
Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data.
Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H, Williamson I, Bucher HC.
Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland. jyoung@uhbs.ch
BACKGROUND: Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. We undertook a meta-analysis of randomised trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics.
METHODS: We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials. Individual patients' data from 2547 adults in nine trials were checked and re-analysed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needed to treat (NNT) with antibiotics to cure one additional patient.
FINDINGS: 15 patients with rhinosinusitis-like complaints would have to be given antibiotics before an additional patient was cured (95% CI NNT[benefit] 7 to NNT[harm] 190). Patients with purulent discharge in the pharynx took longer to cure than those without this sign; the NNT was 8 patients with this sign before one additional patient was cured (95% CI NNT[benefit] 4 to NNT[harm] 47). Patients who were older, reported symptoms for longer, or reported more severe symptoms also took longer to cure but were no more likely to benefit from antibiotics than other patients.
INTERPRETATION: Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.
