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For children diagnosed with acute sinusitis, antibiotic treatment showed minimal benefits for those without nasopharyngeal bacterial pathogens. Importantly, the effectiveness of antibiotics did not vary based on nasal discharge color.
In a randomized clinical trial, researchers at six US institutions have uncovered significant insights into the treatment of acute sinusitis in children. The study, involving 515 pediatrics aged 2 to 11 years suffering from acute sinusitis, challenged the conventional use of antibiotics in certain cases.
Children who lacked nasopharyngeal bacterial colonization experienced significantly fewer benefits from antibiotic treatment compared to their counterparts colonized with pathogens.
Furthermore, the impact of antibiotics remained consistent regardless of the color of nasal discharge. Its objective was to determine variations in symptom burden among subgroups defined by the presence of nasopharyngeal Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis through bacterial culture. Additionally, the trial aimed to examine differences based on the presence of colored nasal discharge.
The interventions included oral Amoxicillin (90 mg/kg/day) and Clavulanate (6.4 mg/kg/day) for 254 participants, while 256 received a placebo, all administered over a 10-day period. The key endpoints and measures focused on symptom burden, evaluated through daily scores on a validated scale (ranging from 0 to 40) during the 10 days post-diagnosis. Secondary endpoints encompassed therapy failure, adverse events (encompassing clinically significant diarrhea), and the utilization of resources by families.
Key findings:
The findings suggest that a more targeted approach to antibiotic treatment, guided by the presence of specific bacterial pathogens, could be a viable strategy. Identifying children who are less likely to benefit from antibiotics on presentation may lead to a more judicious use of these medications and potentially minimize antibiotic resistance.
JAMA
Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial
Nader Shaikh et al.
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