Most children with acute sinusitis recover without antibiotics

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Antibiotics do not help most children with acute sinusitis, according to a study in the April 2001 issue of Pediatrics. This finding raises questions about the common practice of prescribing antibiotics to children with long-lasting sinus symptoms.

"Most children with prolonged cold-like symptoms suggestive of acute sinus disease get better within three weeks — without antibiotic therapy," stated Jane Garbutt, M.B., Ch.B., instructor of medicine at Washington University School of Medicine in St. Louis. "Our study suggests that, for children with uncomplicated acute sinusitis, it makes sense to delay antibiotic treatment and watch carefully."

"Antibiotics are expensive and can cause side effects, most commonly diarrhea," Garbutt said. "Another concern is that they are an important factor in the emergence and spread of antibiotic-resistant bacteria."

The researchers studied 180 pediatric patients ages 1 to 18 whose sinus symptoms had persisted for 10 to 28 days. Once the patients were clinically diagnosed with acute sinusitis, they were assigned randomly to one of three groups. For 14 days, one group took the antibiotic amoxicillin, the second took the antibiotic amoxicillin-clavulanate, and the third took an inactive substance.

A pharmacist distributed the medications so no one knew what patients were in which group.

The researchers phoned each patient or caregiver seven times over the next two months to see if sinus symptoms were still present and if they were better or worse. Side effects of treatment, a relapse or recurrence of sinusitis and parent satisfaction with treatment also were noted.

79% of the children on amoxicillin improved after 14 days, as did 81% of those on amoxicillin-clavulanate and 79% of those on the placebo. Side effects such as nausea and diarrhea were more common among the children taking an antibiotic, appearing in 19% of those on amoxicillin, 11% of those on amoxicillin-clavulanate and 10% of the placebo group.

Some patients who improved initially then relapsed after three or four weeks. Other patients' symptoms reappeared in the second month after treatment began. However there were no differences among the three groups.

"In a sense, we have met the enemy, and we are it," said Elliot Gellman, M.D., clinical professor of pediatrics. "Many people who come into the office say they are there to get antibiotics for sinus problems."

Dr. Gellman, who also is on the staff of St. Louis Children's Hospital, acknowledged the difficulty of changing the way pediatricians interact with patients and parents. "Giving an antibiotic is the quickest way to bring an appointment to an end," he admitted. "But it turns into a communication issue — something we should deal with."

SOURCES: Pediatrics, April 2001.

Media Advisory, Washington University School of Medicine, April 2, 2001.

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