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Subacute sinusitis: are antimicrobials necessary?

A W Dohlman1, M P Hemstreet, G T Odrezin

  • 1Department of Pediatrics, University of Alabama School of Medicine, Birmingham.

The Journal of Allergy and Clinical Immunology
|May 1, 1993
PubMed
Summary

For children with subacute sinusitis, antimicrobials did not significantly improve treatment outcomes compared to no antimicrobial medication. Treatment response rates were similar between groups, indicating limited added benefit from antibiotics.

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Area of Science:

  • Pediatric infectious diseases
  • Otolaryngology

Background:

  • Subacute sinusitis treatment in children requires evaluation of antimicrobial necessity.
  • 96 afebrile children were studied, receiving either antimicrobial medication or no antimicrobials alongside supportive care.

Purpose of the Study:

  • To evaluate the efficacy of antimicrobials in treating subacute sinusitis in children.
  • To compare treatment outcomes between children receiving antimicrobials and those not.

Main Methods:

  • Children received either amoxicillin, amoxicillin clavulanate potassium, trimethoprim-sulfamethoxazole, or no antimicrobial, plus decongestant and saline nasal spray for 3 weeks.
  • Treatment response was assessed via radiologic clearing of abnormalities or significant reduction in mucosal thickening (< 6 mm) with clinical improvement.

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  • Nonresponse was defined as no change or worsening of clinical and radiologic findings.

    • Main Results:

    • Overall, 70% of children responded to treatment, with 87% responding within 3 weeks and 13% within 6 weeks.
    • Fifty-five responders received antimicrobials, while 12 received no antimicrobials.
    • Thirty percent did not respond; 22 of these were on antimicrobials, and 7 were not.

    Conclusions:

    • Similar numbers of responders and nonresponders were observed in both antimicrobial and nonantimicrobial groups.
    • No specific antimicrobial agent demonstrated superior effectiveness in treating subacute sinusitis in this cohort.
    • The findings suggest that antimicrobials may not be necessary for all cases of pediatric subacute sinusitis.