New US research suggests antibiotics offer little benefit in treating most acute sinus infections in children, despite guidelines that recommend their use when symptoms last at least 10 days.
Given growing concern that the overuse of antibiotics creates
drug-resistent germs, the authors say their findings indicate such
guidelines should be revised.
Acute sinusitis is an inflammation of membranes lining the
facial sinuses -- air spaces among bones that surround the nose and
eyes. It affects perhaps 20 million US adults and children yearly
and is among the most common childhood ailments for which
antibiotics are routinely prescribed, said lead researcher Dr. Jane
Garbutt of Washington University School of Medicine.
Sinusitis can be caused by viruses or, less commonly, bacteria;
the only ``bugs'' antibiotics work against are bacteria. Serious
complications such as meningitis can occur with either form but are
The ailment is difficult to diagnose in children because their
symptoms often are simply those of a lingering cold and cough
without the facial pain and fever typically seen in adults.
The study, which involved 161 American children with up to four
weeks of symptoms and diagnosed with acute sinusitis, appears in
April's edition of Pediatrics.
The youngsters, aged 8 on average, were given one of two common
penicillin-type amoxicillin drugs or dummy pills for two weeks. By
the 14th day of treatment, about 80 percent of patients in each of
three groups showed similar improvement.
``Antimicrobial treatment offered no benefit in overall symptom
resolution, duration of symptoms, recovery to usual functional
status, days missed from school or child care, or relapse and
recurrence of sinus symptoms,'' the authors wrote.
The results echo research on adults and follow recommendations
issued in March by the American College of Physicians-American
Society of Internal Medicine. That group says over-the-counter
remedies rather than antibiotics generally are the best treatment
for most sinus infections in adults.
Existing guidelines for children stem from a 1998 consensus
statement by specialists at the US Centers for Disease Control
and Prevention and elsewhere. They note that sinus infections
caused by viruses are up to 200 times more common than those caused
Nevertheless, the guidelines recommend treatment with
amoxicillin or similar drugs for children with upper respiratory
symptoms such as nasal discharge of any color and cough who don't
improve after 10 to 14 days.
It was once thought that greenish mucous signaled a bacterial
infection but doctors now believe it is simply a sign of
inflammation, Garbutt said.
She said the findings suggest that doctors wait until symptoms
have lasted at least three weeks before prescribing antibiotics.
The American Academy of Pediatrics follows the 1998
recommendations but its Committee on Quality Improvement is
developing its own guidelines that should be completed in the next
few months, a spokeswoman said.