ALLIE MILLER
Pittsburgh Post-Gazette JUL 27, 2023 8:01 AM
One of the most common diseases seen in children is acute sinusitis, which tends to be treated with antibiotics. A new study by researchers at the University of Pittsburgh and UPMC explored a way to limit antibiotic use, which comes with potential side effects, to those young patients who would most benefit.
For the 5 million kids in the U.S. being prescribed antibiotics for acute sinusitis each year, only about half of them experience any improvement with antibiotic use, said Dr. Nader Shaikh, lead author of the study, published Wednesday in JAMA Network. Dr. Shaikh is a pediatrician at UPMC Children’s Hospital of Pittsburgh.
“There was a clinical need to do this study because the diagnosis of sinusitis is very imprecise,” said Dr. Shaikh, a factor that he found to be “very unsatisfying.”
“Sinusitis is one of the most common diseases we see in children, but it’s difficult to diagnose because it’s based on the duration of symptoms: If the child has a runny nose or congestion for more than 10 days, we suspect sinusitis,” he said in a news release about the study.
Dr. Shaikh and his team searched for a better way.
In a randomized clinical trial of about 500 American children, ages 2 to 11, researchers found that kids who tested positive for bacteria had improvement of symptoms on antibiotics compared to those who did not test positive The trial was conducted from February 2016 to April 2022.
If the acute sinusitis is non-bacterial, that means it is viral and will go away on its own without treatment, meaning antibiotics would provide no help.
Ideally, Dr. Shaikh said, the diagnostic process of acute sinusitis would look similar to how doctors test for strep throat. “Instead of swabbing the throat, we will swab the nose. And if those bacteria are present, we will consider treatment, and if they’re not present, we assume it’s a virus,” he explained.
But moving to nasal swabs for bacterial testing for every child is a bit tricky, Dr. Shaikh said. That’s because there is no bedside test for acute sinusitis, one that could give quick results such as the at-home rapid COVID-19 test.
Currently there are two testing options, and both take time. A bacteria culture, which tests for a bacterial infection, can take a few days for results. The other option is a polymerase chain reaction, or PCR, test, which gives results within a few hours or by the following morning, he said.
The researchers’ next step is looking at how to roll out nasal testing, ideally with an improved tool.
Dr. Brian Donnelly, a pediatrician at Allegheny Health Network, said it would be unusual now for him to do a nasal swab for children he diagnoses with acute sinusitis. But if there were an effective tool to detect bacterial sinusitis, he said he would use it.
The nasal swab can also be expensive, as it requires a specialized piece of equipment, and the swabs, if not used in a specific time, can expire, said Dr. Jesse Hackell, chairman of the Committee on Practice and Ambulatory Medicine at the American Academy of Pediatrics.
While Dr. Hackell finds the study to be useful, he prefers the method commonly used with ear infections of “watchful waiting” over immediate treatment with antibiotics or performing a nasal swab test on a child. Watchful waiting saves “the cost of the health care system in terms of testing, it could save the trauma to the kid in terms of a nasal swab, and it could save the risk of the antibiotics of allergic reactions or other adverse events. … ”
If a child’s symptoms worsen, then a treatment plan could be devised that could mean either antibiotics or a test for bacteria, Dr. Hackell said.
A constant concern in pediatrics is the unnecessary use of antibiotics, Dr. Hackell said, which is another reason he finds watchful waiting to be the most appropriate and least aggressive approach toward acute sinusitis treatment.
Prescribing antibiotics can cause side effects like diarrhea, rashes and changes in the microbiome and gut flora, said Dr. Donnelly, making them especially unnecessary if the antibiotics are not even helpful.
The study also found that the color of nasal discharge is not an indicator of a bacterial infection. It is a common misconception among parents and doctors that green or yellow discharges from the nose signal bacterial infection, but Dr. Shaikh said “color should not be used to guide medical decisions.”
Dr. Hackell agreed. While the green and yellow color might mean bacteria is present, it does not mean that it needs to be treated, he said.
Leave a Reply