Antimicrobial therapy for children with adenotonsillar hypertrophy and obstructive sleep apnea: a prospective
Debra M Don1, Nira A Goldstein, Dennis M Crockett
1Division of Pediatric Otolaryngology and Pulmonology, Children's Hospital, Los Angeles, CA, USA. ddon@chsd.org
Insights
A pilot study found that a broad-spectrum antibiotic may temporarily improve obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy. However, the antibiotic did not eliminate the need for surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pharmacology
Background:
- Recurrent tonsillitis treatment with antibiotics is established, but their role in adenotonsillar hypertrophy and obstructive sleep apnea (OSA) is unclear.
- Antibiotics may potentially reduce adenotonsillar size and improve OSA symptoms, possibly avoiding surgery.
Purpose of the Study:
- To assess the efficacy of a broad-spectrum antibiotic for managing adenotonsillar hypertrophy and OSA in children.
- To determine if antibiotic treatment can obviate the need for surgical intervention.
Main Methods:
- A double-blinded, prospective clinical trial involving 22 children (ages 2-12) with OSA.
- Participants were randomized to receive either azithromycin or a placebo for 30 days, with polysomnography performed pre- and post-treatment.
Main Results:
- Polysomnographic indices suggested improvement in the antibiotic group compared to placebo, but this did not reach statistical significance.
- Only 9% of children receiving antibiotics experienced normalization of their OSA parameters.
Conclusions:
- A course of broad-spectrum antibiotics may offer temporary improvement in OSA associated with adenotonsillar hypertrophy.
- Current evidence suggests antibiotics do not eliminate the need for surgical management in these cases.
Objective:
Multiple clinical trials demonstrate the value of administering antibiotics for recurrent tonsillitis. However, there is no consensus as to the role of antibiotics in the management of adenotonsillar hypertrophy and obstructive sleep apnea (OSA). It has been suggested that antibiotics may reduce adenotonsillar size, improve obstructive symptoms, and obviate the need for surgery. The goal of this pilot study was to evaluate the efficacy of a broad-spectrum antibiotic in the management of adenotonsillar hypertrophy and OSA.
Methods:
Twenty-two children ages 2 through 12, with evidence of OSA, were enrolled in this double-blinded, prospective clinical trial. Children were randomly assigned into 1 of 2 groups. Group I received azithromycin for a 30-day period (12 mg/kg on days 1-5; the regimen was repeated on days 11-15 and days 21-25). Group II received a placebo administered in the same regimen for a 30-day period. Overnight polysomnography was performed before and within 2 weeks after drug administration.
Results:
Polysomnographic indices of OSA severity appear to indicate an improvement in the antibiotic as compared to the placebo group, but a comparison of mean +/- standard error for each parameter failed to demonstrate statistical significance using the paired t test. Only 1 of 11 (9%) children had normalization of their polysomnographic parameters.
Conclusions:
These results suggest that a course of a broad-spectrum antibiotic may be effective in temporarily improving OSA due to adenotonsillar hypertrophy, but does not appear to obviate the need for surgery.
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