Predicting Response to Antimicrobial Therapy in Children with Acute Sinusitis

Objective To determine prognostic factors that independently predict response to antimicrobial therapy in children with acute sinusitis. Study design A total of 206 children meeting a priori clinical criteria for acute sinusitis who were prescribed antimicrobial therapy by their primary care provide...

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Bibliographic Details
Published in:The Journal of pediatrics 2014-03, Vol.164 (3), p.536-541
Main Authors: Shaikh, Nader, MD, MPH, Wald, Ellen R., MD, Jeong, Jong H., PhD, Kurs-Lasky, Marcia, MS, Bowen, A'Delbert, MD, Flom, Lynda L., MD, Hoberman, Alejandro, MD
Format: Article
Language:English
Subjects:
Acute Disease
Amoxicillin - therapeutic use
Amoxicillin-Potassium Clavulanate Combination - therapeutic use
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Female
Haemophilus influenzae - isolation & purification
Humans
Male
Moraxella (Branhamella) catarrhalis - isolation & purification
Nasopharynx - microbiology
Pediatrics
Prognosis
Prospective Studies
Sinusitis - drug therapy
Sinusitis - microbiology
Streptococcus pneumoniae - isolation & purification
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Summary:Objective To determine prognostic factors that independently predict response to antimicrobial therapy in children with acute sinusitis. Study design A total of 206 children meeting a priori clinical criteria for acute sinusitis who were prescribed antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8-12 days after treatment was initiated was followed with the use of a validated scale. We examined the univariate and multivariate association between factors present at the time of diagnosis (symptoms, signs, nasopharyngeal culture result, radiograph results) and time to resolution of symptoms. This study was conducted 8-10 years after the 7-valent pneumococcal conjugate vaccination was introduced but before introduction of the 13-valent pneumococcal conjugate vaccination. Results Children with proven nasopharyngeal colonization with Streptococcus pneumoniae improved more rapidly (6.5 vs 8.5 median days to symptom resolution) than those who were not colonized with S pneumoniae . Age and radiograph findings did not predict time to symptom resolution. Conclusions In children with acute sinusitis, proven nasopharyngeal colonization with S pneumoniae at presentation independently predicted time to symptom resolution. Future randomized, placebo-controlled trials could investigate the usefulness of testing for the presence of nasopharyngeal pathogens as a predictor of response to treatment.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2013.11.021