Treat Sinusitis in Kids Less Aggressively, Says AAP Guideline

Last Updated: 2013-07-04 9:00:31 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Children with persistent sinusitis may be treated with antibiotics or observed for a few days to see if they get better on their own, according to updated guidelines from the American Academy of Pediatrics (AAP).

"Most children with a runny nose do not need antibiotics," lead author Dr. Ellen R. Wald told Reuters Health by email. "These new guidelines will help pediatricians accurately diagnose which children have a common cold -- which antibiotics won't help -- and which children have a bacterial infection that will get better with antibiotics."

In a statement aimed at parents, Dr. Wald, chair of the AAP Subcommittee on Acute Sinusitis, said "Children with persistent sinusitis may be managed with either an antibiotic or with an additional brief period of observation, allowing the child up to another 3 days to fight the infection and improve on his or her own."

"The choice to treat or observe," she added, "should be discussed with your doctor and may be based on your child's quality of life and how much of a problem the sinusitis is causing. In contrast, all children diagnosed with severe or worsening sinusitis should start antibiotic treatment to help them recover faster and more often."

Dr. Wald also said that although antibiotic treatment may be expected, it may not be appropriate.

"Some episodes of persistent sinusitis include relatively mild symptoms that may improve on their own in a few days. In addition, antibiotics can have adverse effects, which may include vomiting, diarrhea, upset stomach, skin rash, allergic reactions, yeast infections, and development of resistant bacteria (that make future infections more difficult to treat)."

The guidelines were published online on June 24 in Pediatrics. They discourage clinicians from obtaining "imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI (upper respiratory infection), because they do not contribute to the diagnosis."

Amoxicillin with or without clavulanate is recommended as first-line treatment of acute bacterial sinusitis. "Clinicians should reassess initial management if there is either a caregiver report of worsening (...) or failure to improve within 72 hours of initial management," the guidelines say.

Nevertheless, the authors note that evidence is scant. Since 2001, when the previous guideline was released, "Ironically, the number of published guidelines on the topic (5) exceeds the number of prospective placebo-controlled clinical trials of either antibiotics or ancillary treatments of acute bacterial sinusitis."

According to Dr. Michael J. Smith, author of a technical report accompanying the guidelines, "There are only a few high-quality randomized controlled studies focusing on the treatment of acute bacterial sinusitis in children. Two showed that antibiotics helped treat sinusitis and the others did not. This was in large part due to different characteristics -- such as severity of illness -- between the children enrolled in each study."

"Examining these differences, allowed our guideline committee to make an evidence-based recommendation about which children warrant treatment for sinusitis," Dr. Smith, of the University of Louisville School of Medicine in Kentucky, told Reuters Health by email.

The technical report also points out that the efficacy of decongestants and antihistamines for sinusitis has not been proven. "Given recent concerns regarding their safety profile in young children, the use of these agents should be avoided," the report says.

SOURCE: http://bit.ly/11RJEYT and http://bit.ly/15Mj7xn

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