Antibiotic use for Acute Sinusitis in Children has Minimal Benefit with increased Diarrhea Risk

Antibiotic treatment for acute sinusitis in children provides only minimal benefit and may lead to more cases of clinically significant diarrhea, according to a randomized trial conducted by researchers led by Nader Shaikh, MD, MPH, from UPMC Children's Hospital of Pittsburgh. The study published in JAMA involved children between the ages of 2 and 11 years with heart failure (HF) and atrial fibrillation (AF).

In the study, 103 children received a 10-day course of oral amoxicillin and clavulanate (antibiotic group), while 2,683 children received a placebo (control group). ● The researchers found that the mean symptom scores during the first 10 days were significantly lower in the antibiotic group (9.04) compared to the control group (10.60) on the Pediatric Rhinosinusitis Symptom Score, resulting in a significant between-group difference of -1.69 on the 40-point scale.

● The antibiotic treatment also reduced the time to symptom resolution, with children in the antibiotic group recovering in 7 days, compared to 9 days in the placebo group.

● The antibiotic group had a lower likelihood of experiencing treatment failure, developing acute otitis media, or receiving additional systemic antibiotics compared to the placebo group.

● The study also revealed that the antibiotic group had a higher incidence of clinically significant diarrhea (11.4% vs. 4.7%), which may raise concerns about the use of antibiotics for acute sinusitis in children.

The study suggests that antibiotic use for acute sinusitis in children may provide mild relief in symptom burden, especially for those with common respiratory bacteria detected in their nasopharynx. However, the decision to use antibiotics in such cases should be weighed against the potential risk of adverse effects like diarrhea.

"Overall, the current study suggests that antibiotics may provide mild relief in symptom burden in children with acute bacterial sinusitis, especially in those with common respiratory bacteria," they concluded. "However, given the limitations of nasopharyngeal bacterial pathogen testing, widespread adoption of a test-based treatment approach is not there yet."

The researchers propose that a point-of-care test option for acute bacterial rhinosinusitis could help reduce unnecessary antibiotic prescriptions, and they are hopeful that such testing may become more feasible and acceptable, especially in the context of the COVID-19 pandemic where swabbing is more frequently accepted.

In conclusion, the study sheds light on the limited benefit of antibiotic treatment for acute sinusitis in children and highlights the need for careful consideration of treatment options, taking into account individual patient factors and the potential risks and benefits of antibiotic use.

Reference:

JAMA Shaikh N, et al "Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial" JAMA 2023; DOI: 10.1001/jama.2023.10854.