Antibiotics Ineffective for Treatment of Children with Acute Sinitus
Acute sinitus, or inflammation of the membranes lining the sinuses, is among the most prevalent of childhood ailments for which antibiotics are routinely prescribed. Although antimicrobial treatment for children with acute sinusitis is used commonly, it is unclear whether it offers significant clinical benefit.
Guidelines exist that recommend the use of drugs such as amoxicillin as first line defense for children who have rhinosinusitis and cough without improvements for 10-14 days. These same guidelines do not recommend diagnostic imaging either, yet evidence to support these recommendations is lacking. The purpose of this study was to evaluate the effectiveness of antimicrobial treatments for acute sinusitis.
A total of 188 patients (ages 1-18 and with 10 to 28 days of persistent sinus symptoms, and a clinical diagnosis of acute sinitus) were randomized to receive 14 days of amoxicillin (40 mg/kg/day in three doses), amoxicillin-clavulanate (amoxicillin 45 mg/kg/d in two daily doses), or placebo. Changes in sinus symptoms were measured using a symptom score; outcomes were assessed by telephone interviews over a two-month period.
Of the 161 patients included in the analysis, 58 received amoxicillin, 48 received amoxicillin-clavulanate, and 55 received placebo. There was no significant difference in improvement rates 14 days
after the initiation of treatment. The rates of adverse events and relapse of sinus symptoms were similar among treatment groups.
Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children diagnosed acute sinitus.
This was a great study because it compared the results of a first line antibiotic with a broad spectrum antimicrobial as well as a placebo. It helps to better understand the appropriate care to offer children with sinusitis and may help change current guidelines.
Garbutt JM, Goldstein M, Gellman E, et al. A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinitus. Pediatrics
2001:107(4), pp. 619-625.