Antibiotics use for acute sinusitis in children reduces treatment failures: Insights from meta-analysis

In the study published in the Pediatrics Journal, antibiotics significantly reduced treatment failure rate compared with placebo in children with clinically diagnosed acute sinusitis. However, given the favorable natural history of sinusitis, the results could also support close observation without immediate antibiotic treatment.

The meta-analysis provides valuable insights into the use of antibiotics for acute sinusitis in children, highlighting the importance of evidence-based decision-making and antibiotic stewardship in pediatric practice

In children, acute sinusitis is one of the leading causes of antibiotic prescriptions. No recent systematic reviews have examined antibiotic efficacy compared with placebo.

The meta-analysis, conducted by Shannon J. Conway, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, and colleagues sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.

For this purpose, Embase and Medline were searched from their origin to July 2023. Randomized placebo-controlled studies focusing on the treatment of acute sinusitis were considered. In all studies, symptoms were present for <4 weeks, and subjects were <18 years of age. Data extraction was done independently by two authors. Data was pooled primarily using fixed-effects models.

The researchers reported the following findings:

• Analysis of 6 included studies showed that antibiotic treatment reduced treatment failure rate by 41% (with a risk ratio of 0.59) compared with placebo.
• There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%).
• Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62).

In conclusion, antibiotics effectively reduce the symptoms of children with clinically diagnosed acute sinusitis. However, given the favorable natural history of the condition, the results could also be viewed as supporting close observation without immediate antibiotic treatment.

"Our results underscore the importance of shared decision-making with parents of children with acute sinusitis," the researchers wrote.

The main limitation was that few studies were eligible for inclusion. The included studies differed in their methodology.

Reference:

Shannon J. Conway, Grace D. Mueller, Nader Shaikh; Antibiotics for Acute Sinusitis in Children: A Meta-Analysis. Pediatrics 2024; e2023064244. 10.1542/peds.2023-064244