PURPOSE OF THE STUDY.
To provide a systematic review of the current evidence for the efficacy of antibiotics compared with placebo in the treatment of acute rhinosinusitis in children.
The authors searched Medline, Embase, and Cochrane Register for randomized controlled studies investigating the efficacy of antibiotics compared with children for treatment of acute sinusitis or acute rhinosinusitis for children between 1 and 18 years of age.
Ninety-six articles were identified in the search, with 84 articles being excluded for various reasons including not being a randomized controlled trial, not including children, not studying acute rhinosinusitis, not comparing antibiotics versus placebo, and/or repeat citation. Twelve studies were included for full text scrutiny with only 4 studies fulfilling selection criteria. The results of the meta-analysis suggest a benefit for those participants treated with antibiotics odds ratio 2.0 (95% confidence interval 1.16–3.47). Analysis is weakened by the low number of randomized controlled trials. Risks for internal bias were thought to be small, but external bias appeared significant. External bias included exclusion of patients with more severe disease, usage of ancillary medications and or saline nasal rinses, and differing antibiotics and varying age range.
Despite the positive findings of the statistical analysis favoring antibiotics for acute rhinosinusitis in children, the authors conclude that routine treatment with antibiotics remains uncertain. Gastrointestinal adverse reactions were nearly 3 times more common in those children treated with antibiotics compared with placebo. Children treated with placebo did not experience significant complications.
Children can experience between 6 and 8 viral upper respiratory infections (URI) each year. As a clinician, it can be difficult at times to differentiate between a viral URI versus acute bacterial rhinosinusitis. Acute bacterial sinusitis is more likely when the presentation includes persistence of symptoms beyond 10 days, severe symptoms including fever ≥102° with purulent nasal discharge, facial pain lasting 3 to 4 days at the beginning of the illness, or worsening symptoms after a typical URI that lasted for 5 to 6 days with new onset of fever, headache, or increased nasal discharge. It is important to remember that a small percentage of URIs (5%–13%) become complicated by bacterial rhinosinusitis.
- Copyright © 2013 by the American Academy of Pediatrics