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To systematically review the evidence for the effectiveness of antibiotics in acute purulent rhinitis (many guidelines advise against their use on the basis of one study that showed no effect).Medline, Embase, Cochrane Register of Controlled Trials, and reference lists of retrieved articles. Review methods Meta-analysis of data from double blind randomised placebo controlled trials comparing antibiotics with placebo for acute purulent rhinitis (duration less than 10 days).Seven studies were retrieved; four contributed data on benefits of antibiotics, and four contributed data on harms of antibiotics. The pooled relative risk of benefit for persistent purulent rhinitis at five to eight days with antibiotics was 1.18 (95% confidence interval 1.05 to 1.33). The numbers needed to treat ranged from 7 to 15 when the pooled relative risk was applied to the range of control event rates. The relative risk for adverse effects with antibiotics was 1.46 (1.10 to 1.94). The numbers needed to harm for adverse effects ranged from 12 to 78. No serious harms were reported in the placebo arms.Antibiotics are probably effective for acute purulent rhinitis. They can cause harm, usually in the form of gastrointestinal effects. Most patients will get better without antibiotics, supporting the current “no antibiotic as first line” advice.