In The News: Does Evidence Fully Support Antibiotic Use for Acute Sinusitis in Kids?

Medpage Today reports on meta-analysis performed to examine the efficacy of antibiotics for acute sinusitis. It was the first such analysis on this since 2013 and included 956 pediatric participants across six randomized placebo-controlled studies. Moderate-certainty evidence showed a significant benefit for antibiotic treatment, with absolute treatment failure rates of 23% for antibiotic-treated patients versus 40.8% for placebo recipients.

The researchers used trials conducted since the last meta-analysis to look at the efficacy of antibiotics for acute sinusitis given that the condition is one of the leading indications for antibiotic prescription in children. The study looked at children given low-dose amoxicillin with or without clavulanate; cefuroxime; or high-dose amoxicillin or clavulanate, or placebo. The treatment duration for all studies was 10-14 days. While the researchers concluded the results “demonstrate the efficacy of antibiotics,” they noted that none of the 431 placebo-treated children developed major sequalae and their results “could also be viewed as supporting observation.”

Three trials showed evidence of a higher risk for diarrhea with antibiotics versus placebo (13.4% vs 7.2%; RR 1.62, 95% CI 1.04-2.51). The study found six children needed antibiotics to prevent one additional treatment failure. Also, it found one additional case of diarrhea would occur for every 16 patients treated. Five of the six trials from the meta-analysis were deemed low risk of bias. Primary outcome analyses that excluded the study with a high risk of bias showed a similar benefit of antibiotic treatment, with a 36% reduced risk of treatment failure (RR 0.64, 95% CI 0.53-0.79). 

Study authors noted limitations to the meta-analysis. They included variations in the included studies’ methodology, treatment failures categorizations, lack of studies examining the impact of antibiotics on nasal or gut microbiomes.

PIDS members Tim Savage and Matthew Kronman authored an invited commentary. In it they wrote, “This finding is an enticing first hint that rapid tests with a high negative predictive value and specificity may allow clinicians to discriminate patients with sinusitis who could benefit from antibiotics from those unlikely to benefit. Until such a cheap, accurate, and rapid test is widely available, however, clinicians must weigh the potential benefits of improved symptom duration with antibiotic treatment among patients meeting the AAP diagnostic criteria against the increased risk of diarrhea and the potential (but unmeasured) microbiome disruption among treated patients.”