Written by Kimi Dunbar
Spoon Feed
While updates to national guidelines have not been made in the past 10 years, recent data suggest that children with mild acute bacterial rhinosinusitis (ABRS) may not need antibiotics, and that, when indicated, amoxicillin has similar efficacy to amoxicillin-clavulanate.
Synopsis
This article reviews the management of acute bacterial rhinosinusitis (ABRS) in children, emphasizing that most pediatric ABRS cases are mild and can resolve without antibiotics. Although national guidelines recommend antibiotics for ABRS, evidence suggests that antibiotics may benefit only a subset of children, especially those with severe symptoms or positive nasopharyngeal cultures. Studies comparing amoxicillin and amoxicillin-clavulanate indicate similar treatment efficacy, with amoxicillin generally preferred due to its narrower spectrum and fewer adverse effects. In mild cases, a watchful waiting approach is encouraged to minimize unnecessary antibiotic use, supporting judicious prescribing practices for pediatric ABRS. (AI-generated)
It’s time for sinusitis guidelines 2.0
This JAMA Insights article reviews updates to ABRS research given that national guidelines by the AAP and IDSA have not been updated since 2013 and 2012, respectively. This RCT published in 2023 found that children with a pathogen isolated on nasopharyngeal swab were more likely to benefit from antibiotics independent of the color of nasal discharge. Bacterial swab from the nasopharynx is not currently standard procedure; however, perhaps the implementation of such an approach may be helpful in decreasing the prescription of unnecessary antibiotics. Regarding spectrum of antibiosis – this study found no difference in cure rates between amoxicillin-clavulanate and amoxicillin alone. I’m inclined to utilize amoxicillin rather than amoxicillin-clavulanate for the treatment of sinusitis, especially in non-severe cases, but this is such a departure from current practice patterns, I am hesitant. I’d really like to see the guidelines from either the AAP or the IDSA updated to reflect this.
Source
Antibiotics for Pediatric Acute Bacterial Sinusitis. JAMA. 2024 Oct 16. doi: 10.1001/jama.2024.2018. Epub ahead of print. PMID: 39412765
Another Spoonful
Here are the references for the studies linked above:
Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial. JAMA. 2023 Jul 25;330(4):349-358. doi: 10.1001/jama.2023.10854. Erratum in: JAMA. 2024 Jul 9;332(2):173. doi: 10.1001/jama.2024.11869. PMID: 37490085
Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis. JAMA. 2023 Sep 19;330(11):1064-1073. doi: 10.1001/jama.2023.15503. Erratum in: JAMA. 2024 Sep 10;332(10):844-845. doi: 10.1001/jama.2024.16020. Erratum in: JAMA. 2024 Sep 10;332(10):845. doi: 10.1001/jama.2024.15865. PMID: 37721610
