Affiliation:
1. Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Abstract
CONTEXT
Acute sinusitis is one of the leading causes of antibiotic prescriptions in children. No recent systematic reviews have examined the efficacy of antibiotics compared with placebo.
OBJECTIVE
We sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.
DATA SOURCES
Medline and Embase were searched from their origin to July 2023.
STUDY SELECTION
We considered randomized placebo-controlled studies focusing on the treatment of acute sinusitis. In all studies, symptoms were present for <4 weeks and subjects were <18 years of age.
DATA EXTRACTION
Two authors independently extracted the data. We pooled data primarily using fixed-effects models.
RESULTS
Analysis of 6 included studies showed that antibiotic treatment reduced the rate of treatment failure by 41% (with a risk ratio of 0.59; 95% confidence interval 0.49–0.72) compared with placebo. There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%). Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62, 95% confidence interval 1.04–2.51).
LIMITATIONS
A small number of studies were eligible for inclusion. Included studies differed in their methodology.
CONCLUSIONS
In children with clinically diagnosed acute sinusitis, antibiotics significantly reduced the rate of treatment failure compared with placebo. However, given the favorable natural history of sinusitis, our results could also support close observation without immediate antibiotic treatment.
Publisher
American Academy of Pediatrics (AAP)
Cited by
1 articles.
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