A new review challenged existing guidelines for treating pediatric patients with acute bacterial rhinosinusitis.
In the study, published in JAMA, researchers from the Children's Hospital of Philadelphia examined evidence published since 2013, suggesting that recommendations for first-line antibiotic therapy may warrant revision.
The review highlighted that antibiotic provided modest benefits, primarily among pediatric patients with positive nasopharyngeal cultures. In a clinical trial by Shaikh et al, pediatric patients treated with amoxicillin-clavulanate experienced improved sinusitis symptom scores and quicker resolution of symptoms compared with those who received placebo. However, only 26% of the patients in the placebo group required subsequent antibiotic treatment, and adverse events such as diarrhea were more common in the antibiotic group (11% vs 5%).
The review noted that current guidelines from the Infectious Diseases Society of America (IDSA) and the American Academy of Pediatrics (AAP) differ in their first-line antibiotic recommendations. The IDSA recommends amoxicillin-clavulanate, whereas the AAP allows for either amoxicillin or amoxicillin-clavulanate. The review suggested that broader-spectrum antibiotics like amoxicillin-clavulanate may not be necessary for most cases of acute bacterial rhinosinusitis (ABRS), since amoxicillin alone may suffice in many pediatric patients, especially given the evolving microbiology of ABRS.
Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis are the primary bacterial pathogens in ABRS, with many strains showing resistance to amoxicillin alone because of β-lactamase production. Despite this, the researchers noted that most pediatric patients recover without antibiotics, raising questions about the need for routine antibiotic use in cases of nonsevere ABRS.
The researchers advocated for a "watchful waiting" approach for patients with nonsevere symptoms, reserving antibiotics for those with severe symptoms or complications. Given the evolving evidence, they concluded that national guidelines for pediatric patients with ABRS need updating to reflect the data suggesting that antibiotics may not be necessary for most patients.
The authors declared no competing interests.
