Treatment of Children with Sinusitis

The effectiveness of antibiotics in children with sinusitis is uncertain. In a randomized, double-blind trial, 56 children (age range, 1–10 years) with clinical diagnoses of sinusitis received either amoxicillin (90 mg/kg) plus clavulanate potassium (6.4 mg/kg) or placebo for 14 days. Sinusitis was defined as persistent symptoms (nasal discharge, daytime cough) for >10 days, worsening symptoms on or after the sixth day of symptoms, or severe symptoms (temperature ≥102ºF and purulent nasal discharge) for at least 3 consecutive days. Of 2135 children with upper respiratory infection (URI) symptoms who were assessed for eligibility, only 139 (6.5%) met criteria for sinusitis.

Parents were contacted daily, and children were considered cured if their clinical severity score declined by 50%. Children who received antibiotics were significantly more likely to be cured (50% vs. 14%) and less likely to experience treatment failure (14% vs. 68%). Adverse side effects, such as diarrhea, were significantly more common in the antibiotic group (44% vs. 14%).