In a randomized clinical trial, researchers at six US institutions have uncovered significant insights into the treatment of acute sinusitis in children. The study, involving 515 pediatrics aged 2 to 11 years suffering from acute sinusitis, challenged the conventional use of antibiotics in certain cases.

Children who lacked nasopharyngeal bacterial colonization experienced significantly fewer benefits from antibiotic treatment compared to their counterparts colonized with pathogens.

Furthermore, the impact of antibiotics remained consistent regardless of the color of nasal discharge. Its objective was to determine variations in symptom burden among subgroups defined by the presence of nasopharyngeal Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis through bacterial culture. Additionally, the trial aimed to examine differences based on the presence of colored nasal discharge.

The interventions included oral Amoxicillin (90 mg/kg/day) and Clavulanate (6.4 mg/kg/day) for 254 participants, while 256 received a placebo, all administered over a 10-day period. The key endpoints and measures focused on symptom burden, evaluated through daily scores on a validated scale (ranging from 0 to 40) during the 10 days post-diagnosis. Secondary endpoints encompassed therapy failure, adverse events (encompassing clinically significant diarrhea), and the utilization of resources by families.

Key findings:

• Limited Benefit in Specific Subgroups: A substantial number of children diagnosed with acute sinusitis, particularly those without nasopharyngeal bacterial pathogens, derived minimal benefit from antibiotic treatment. Antibiotic efficacy varied based on the presence of specific pathogens, thus highlighting the need for a more targeted approach to treatment.
• Symptom Burden Reduction: Children administered with oral Amoxicillin and Clavulanate showed a significantly lower mean symptom score (9.04) compared to those in the placebo group (10.60). The reduction in symptom burden was particularly notable in cases where nasopharyngeal bacterial pathogens were detected.
• Time to Symptom Resolution: The study found a vital difference in the time taken for symptom resolution between the antibiotic group (7.0 days) and the placebo group (9.0 days). This underscored the potential benefits of antibiotic treatment in specific cases.
• Colored Nasal Discharge Not a Defining Factor: Contrary to previous assumptions, the study revealed that the color of nasal discharge (colored or clear) did not considerably impact the efficacy of antibiotic therapy. The between-group difference was -1.62 [95% confidence interval [CI], -2.09 to -1.16] for colored nasal discharge while -1.70 [95% CI, -2.38 to -1.03] for clear nasal discharge. This challenged previous perceptions and emphasized the need for a nuanced understanding of symptoms.

The findings suggest that a more targeted approach to antibiotic treatment, guided by the presence of specific bacterial pathogens, could be a viable strategy. Identifying children who are less likely to benefit from antibiotics on presentation may lead to a more judicious use of these medications and potentially minimize antibiotic resistance.