Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 May 1;153(5):e2023064244.
doi: 10.1542/peds.2023-064244.

Antibiotics for Acute Sinusitis in Children: A Meta-Analysis

Shannon J Conway #  1 , Grace D Mueller #  1 , Nader Shaikh  1
Affiliations
Meta-Analysis

Antibiotics for Acute Sinusitis in Children: A Meta-Analysis

Shannon J Conway et al. Pediatrics. .

Abstract

Context: Acute sinusitis is one of the leading causes of antibiotic prescriptions in children. No recent systematic reviews have examined the efficacy of antibiotics compared with placebo.

Objective: We sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.

Data sources: Medline and Embase were searched from their origin to July 2023.

Study selection: We considered randomized placebo-controlled studies focusing on the treatment of acute sinusitis. In all studies, symptoms were present for <4 weeks and subjects were <18 years of age.

Data extraction: Two authors independently extracted the data. We pooled data primarily using fixed-effects models.

Results: Analysis of 6 included studies showed that antibiotic treatment reduced the rate of treatment failure by 41% (with a risk ratio of 0.59; 95% confidence interval 0.49-0.72) compared with placebo. There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%). Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62, 95% confidence interval 1.04-2.51).

Limitations: A small number of studies were eligible for inclusion. Included studies differed in their methodology.

Conclusions: In children with clinically diagnosed acute sinusitis, antibiotics significantly reduced the rate of treatment failure compared with placebo. However, given the favorable natural history of sinusitis, our results could also support close observation without immediate antibiotic treatment.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to report.

Figures

FIGURE 1
FIGURE 1
Study selection process.
FIGURE 2
FIGURE 2
Risk of bias analysis of included studies.
FIGURE 3
FIGURE 3
Risk of treatment failure in children treated with antibiotics compared with placebo.
See this image and copyright information in PMC

Comment in

References

    1. Leung AK, Hon KL, Chu WC. Acute bacterial sinusitis in children: an updated review. Drugs Context. 2020;9:9 - PMC - PubMed
    1. Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med. 1998;152(3):244–248 - PubMed
    1. Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. 2007;119(6):e1408–e1412 - PubMed
    1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864–1873 - PubMed
    1. Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053–1061 - PubMed

Substances