CLINICAL QUESTION

Is antibiotic treatment more effective than placebo in resolving symptoms of acute sinusitis in children?

BOTTOM LINE

Although this study was a meta-analysis, the data largely came from one study that showed a substantial benefit after a few weeks using amoxicillin with or without clavulanate to treat children with symptoms of acute sinusitis. (Level of Evidence = 1a)

SYNOPSIS

The authors searched two databases and identified six studies that compared an antibiotic, usually amoxicillin or amoxicillinclavulanate, with placebo in children at least 1 year of age who had at least 10 days of acute sinusitis symptoms. All but one study was conducted after the Haemophilus influenzae type b vaccine was in widespread use. Treatment failure, defined in most studies as worsening while using the treatment or a lack of improvement after 2 weeks of treatment, was significantly less common in patients who received an antibiotic, with 77% responding to treatment, than in patients who received a placebo, with 59% responding to treatment (number needed to treat = 6). Diarrhea was about twice as common with treatment. The number of studies is too small to differentiate between different antibiotics or low-dose vs high-dose treatment. A single study was much larger than the others combined and contributed most to the outcome. There was significant heterogeneity among the studies, which was resolved when a low-quality study was removed from the analysis.