OBJECTIVES: The objective of this meta-analysis is to review published clinical trials evaluating the relative efficacy of a three-day regimen of azithromycin versus longer courses of comparator antibiotics. METHODS: A literature search using Medline and Embase identified randomized controlled trials that were published in the English language and evaluated the efficacy of a 3-day regimen of azithromycin versus 10 days of active comparators in adult patients with acute sinusitis. Pooled odds ratios were calculated for clinical success (cure + improvement) at the end of therapy (range: day 10-15) using the Mantel-Haenszel fixed-effect and random-effect models. RESULTS: Among the seven eligible studies with 1721 patients, the estimated overall success rate at the end of therapy (random effect odds ratio: 1.13, 95% CI: 0.79-1.62) was in favor of azithromycin, although this difference did not reach statistical significance. There were no differences in findings between the fixed- and random-effect models. CONCLUSIONS: A 3-day regimen of azithromycin has at least comparable efficacy to longer courses of comparator antibiotics.