Viral upper respiratory infections occur frequently during childhood (6-8 per year) and are,
for the most part, self-limited episodes that resolve spontaneously and do not require
antibiotic therapy. Acute otitis media and acute bacterial sinusitis are frequent
complications of viral upper respiratory infections that will benefit from treatment with
antibiotics. Acute bacterial sinusitis is one of the most common diagnoses in ambulatory
practice and, in all age groups, accounts for an estimated 25 million physician office visits
annually. It is essential to distinguish between patients who are experiencing uncomplicated
viral upper respiratory infections and acute bacterial sinusitis to avoid the excessive use
of antibiotics for patients who will not benefit from them. This is especially important now
because of the escalation of antibiotic resistance among the bacteria that commonly cause
acute bacterial sinusitis, acute otitis media and pneumonia. Inappropriate use of antibiotics
is a major contributor to the problem of antimicrobial resistance - a problem which
dramatically increases both the cost and complexity of treatment.
To improve the diagnosis and treatment of patients with acute bacterial sinusitis and reduce
the inappropriate use of antibiotics, clinical guidelines have been developed by three
national organizations: the American Academy of Pediatrics, the Sinus and Allergy Health
Partnership and the Centers for Disease Control and Prevention. Traditionally, the diagnosis
of acute bacterial sinusitis is suspected on the basis of clinical signs and symptoms and is
confirmed with the performance of images (either plain radiographs, computed tomography or
magnetic resonance imaging). All three guidelines recommend that the diagnosis and treatment
of acute bacterial sinusitis should be based on clinical criteria alone without the
confirmation of imaging or other laboratory data. Although the similarity between the
different guidelines suggests that there is widespread consensus to use clinical criteria to
diagnose acute bacterial sinusitis, there is virtually no evidence to support this position.
Specific Aim 1 of this project is to evaluate the use of clinical criteria, without the
performance of images, as the basis for the diagnosis of acute bacterial sinusitis. A
randomized, placebo-controlled study design will be used to determine if the clinical
criteria proposed by the different guidelines can be used to identify children with upper
respiratory symptoms who will respond to antibiotic therapy. It is expected that children
with acute bacterial sinusitis who receive an antimicrobial will recover more quickly and
more often than children who receive placebo.