Antibiotics for Acute Sinusitis in Children: A Meta-Analysis

Area of Science:

• Pediatrics
• Infectious Diseases
• Pharmacology

Background:

• Acute sinusitis is a common reason for pediatric antibiotic prescriptions.
• There's a lack of recent systematic reviews on antibiotic efficacy versus placebo for childhood sinusitis.

Purpose of the Study:

• To evaluate if antibiotics are more effective than placebo for treating acute sinusitis in children.
• To synthesize evidence from placebo-controlled trials on pediatric sinusitis treatment.

Main Methods:

• Systematic review and meta-analysis of randomized placebo-controlled trials.
• Searched Medline and Embase databases up to July 2023.
• Included studies focused on children (<18 years) with sinusitis symptoms <4 weeks.

Main Results:

• Antibiotic treatment decreased treatment failure rates by 41% compared to placebo (RR 0.59).
• Initial heterogeneity among studies decreased after removing a high-risk bias study.
• Antibiotic use increased the risk of diarrhea (RR 1.62).

Conclusions:

• Antibiotics show a significant benefit in reducing treatment failure for pediatric acute sinusitis.
• The favorable natural history of sinusitis suggests observation without immediate antibiotics is a potential alternative.
• Evidence quality was limited by the small number and methodological differences of included studies.