Antibiotics Effective for Acute Sinusitis in Kids, but Observational Approach Also Acceptable

A recent meta-analysis of six pediatric sinusitis studies demonstrated that antibiotics are effective in treating sinusitis in children, although they did cause diarrhea in some patients (Pediatrics. 2024;153:e2023064244). However, delaying antibiotics did not cause major sequelae and may be an appropriate approach for certain patients.

The meta-analysis included 956 children under the age of 18 years who had had symptoms for less than four weeks. Overall, the relative rate of treatment failure was reduced by 41% in patients who received antibiotics (23.0% absolute risk of treatment failure) versus patients who received placebo (40.8% absolute risk of treatment failure).

Of the three studies that reported on side effects, patients receiving antibiotics were 1.6 times more likely to have diarrhea than those in the placebo group. Additionally, none of the 431 children who received the placebo had sinusitis complications due to lack of antibiotics, so the risk of delaying or skipping antibiotic treatment was low. Thus, the authors concluded that “our results underscore the importance of shared decision-making with parents of children with acute sinusitis.”