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Antibiotics Show Little Benefit in Children Without Nasopharyngeal Bacterial Pathogens

Findings show greater benefit in symptom resolution with detected bacterial pathogens but not color of nasal discharge

TUESDAY, Aug. 8, 2023 (HealthDay News) -- In children with acute sinusitis, antibiotic treatment had minimal benefit for those without nasopharyngeal bacterial pathogens, according to a study published in the July 25 issue of the Journal of the American Medical Association.

Nader Shaikh, M.D., M.P.H., from the University of Pittsburgh, and colleagues conducted a clinical trial in which 515 children (aged 2 to 11 years) diagnosed with acute sinusitis based on clinical criteria were randomly assigned to oral amoxicillin (90 mg/kg/day) and clavulanate (6.4 mg/kg/day; 254 patients) or placebo (256 patients) for 10 days. Daily symptom burden was compared between the groups to see if there were differences by nasopharyngeal colonization with bacterial pathogen or color of the nasal discharge.

The researchers found that the mean symptom scores were significantly lower in children in the amoxicillin and clavulanate group (9.04 versus 10.60 in the placebo group) and the length of time to symptom resolution was significantly lower for children in the antibiotic group (7.0 versus 9.0 days). The benefit from antibiotic treatment was greater in children with nasopharyngeal pathogens detected versus those with pathogens detected (between-group difference in mean symptom scores, −1.95 versus −0.88). Efficacy did not differ significantly based on whether colored nasal discharge was present versus not present (the between-group difference was −1.62 versus −1.70).

"Testing for specific bacteria on presentation may represent a strategy to reduce antibiotic use in this condition," the authors write.

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