Running Around with a Runny Nose

Bacterial sinusitis treatments in children are updated with more current research

(RxWiki News) Little kids are notorious for having runny noses a lot of the time. It can be hard to tell the difference between allergies, a cold and a more serious infection. Research data can help.

A recent review of the research looked at the most current studies related to acute bacterial sinusitis in children.

Bacterial sinusitis is a sinus infection (in the nose and throat areas) caused by bacteria.

The review was used to develop new clinical guidelines for doctors in how to treat sinusitis in children. In the new guidelines, doctors should not give children x-rays and they may wait up to three days to give children antibiotics.

"See a pediatrician if your child has 10 days of sinus symptoms."

The study, written by Michael J. Smith, MD, from the University of Louisville School of Medicine, reviewed the most recently published research available for treating bacterial sinusitis in children.

This research led to several changes in the new guidelines for pediatricians in treating bacterial sinusitis in children.

Acute bacterial sinusitis accounts for about 5 to 10 percent of upper respiratory infections in children.

Dr. Smith looked for all randomized, controlled trials that had been published since 2001, when the last guidelines were published.

He located 17 studies that related specifically to treating acute bacterial sinusitis in children.

Four of these studies used a placebo (fake medicine) in a comparison group to test the effectiveness of using antimicrobial therapy in another group. The studies included a total of 392 children.

Antimicrobial therapy is the use of chemicals in medications to kill off microorganisms.

Two of these studies found that the antimicrobial therapy was effective in treating the sinusitis. The other two studies found that it was no different than the placebo.

The studies were too different from each other for Dr. Smith to conclude anything about antimicrobial therapy in general.

Five of the 17 trials Dr. Smith reviewed did not use a placebo in a control group, so they provided less helpful information.

Three of the trials only looked at a subacute bacterial sinusitis in children. This is a different, less severe kind than acute bacterial sinusitis.

Finally, six of the studies he found tested other therapies besides antimicrobial therapy.

The other therapies tested included steroid medications, decongestants or antihistamines, nasal sprays with medication, nasal sprays with saline only and medications called "mucolytic agents." Mucolytic agents are medications that loosen mucus in the sinuses.

Some of these studies found the therapy to be effective in treating the sinusitis, but others found it was not any different than using no medication.

The studies had small numbers of participants, so there was not enough evidence to recommend any treatments of sinusitis besides the current typical treatment.

The current recommended treatment in the new guidelines is prescribing the antibiotic amoxicillin.

Doctors should prescribe this antibiotic if a child comes in with very severe symptoms of sinusitis (a runny nose with non-clear mucus and a fever over 102º Fahrenheit for at least three days).

If a child has a runny nose, cough and minor fever for more than 10 days, doctors can treat the child right away or, with the parents' input, wait up to three days to prescribe antibiotics, according to the new clinical guidelines.

The new guidelines that came from this systematic review recommend that doctors do not give children x-rays.

The new guidelines also suggest that children who get better at first and then have worse symptoms should be treated right away.

The systematic review and guidelines were published June 24 in the journal Pediatrics.

No outside funding was used. Dr. Smith has received research funding in the past from Sanofi Pasteur and Novartis.

Review Date: 
June 21, 2013