To the Editor—

I appreciated the delicious (intended?) irony that Garbutt’s placebo-controlled study of sinusitis treatment, published in Pediatrics,¹ arrived in the same AAP wrapper as Wald’s article in Pediatrics in Review.²

Wald restates her nostrums: diagnose pediatric sinusitis clinically, without sinus films or computed tomography scanning, in children with nasal discharge or cough that persists longer than 10 to 14 days. Treat these patients with amoxicillin, she advises.

But Garbutt et al convincingly show that neither amoxicillin nor amoxicillin-clavulanate offers any benefit compared with placebo in routine sinusitis, as Wald would diagnose it clinically.

I’ve always agreed in principle with Nelkin, whose “Requiem for the Common Cold” satirically suggests that treating “sinusitis” is just the latest, lousy excuse for dispensing antibiotics for upper respiratory tract infections.³ Treating colds with antibiotics is an embarrassing and, thanks to recent studies, poorly kept secret.^4,5 If you can prescribe antibiotics after 10 to 14 days, the reasoning goes, why not save the hassle of a return visit or phone call and use amoxicillin after 5 to 7 days for “early sinusitis.” Parents certainly lead the way down this slippery slope when they insist that “last time the cold turned into sinusitis.”

I wish that I could say I always practice in a high-minded manner, eschewing antibiotics and engaging parents in lengthy discussions about proper antibiotic use that may leave them confused and dissatisfied. Thanks to Garbutt et al, I now have greater impetus to do the right thing.

• Copyright © 2002 by the American Academy of Pediatrics