Acute rhinosinusitis during upper respiratory infection in children

Abstract Acute rhinosinusitis is estimated to be one of the most common diseases in childhood. Still, the diagnostics and clinical relevance of this disease are controversial. Bacterial rhinosinusitis cannot be differentiated from mere rhinitis on clinical grounds alone. Abnormal radiologic findings have been found to be common in child and adult volunteers without sinus symptoms and in adults during viral upper respiratory infection. In children, the results of the few placebo-controlled studies on the benefit of antimicrobial treatment of clinically diagnosed acute rhinosinusitis are controversial. Bacteriologic cultures obtained from the middle meatus by rigid nasal endoscopy have been introduced as a way to determine the bacteriology of the maxillary sinus in adults, but they have not been studied in children with acute symptoms. In this thesis, incidental paranasal abnormalitites were found to be common in healthy school children examined by magnetic resonance imaging (MRI). Some of these abnormalities resolved during a follow-up period of 6 months, but new abnormalities appeared in some children. MRI abnormalities of the paranasal sinuses were found to be much more common in children with acute upper respiratory infections, and most of these abnormalities resolve spontaneously. Children with acute rhinosinusitis confirmed clinically and by imaging did not benefit from cefuroxime treatment as compared to placebo. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) in the nasal middle meatus during acute upper respiratory infection predicted longer duration of the symptoms and signs of common cold. Based on these findings, imaging methods should not be used in the diagnostics of acute rhinosinusitis in children. Similarily, incidental imaging findings of abnormalities in the paranasal sinuses or in children with symptoms of acute rhinosinusitis are not an indication for antimicrobial treatment. Because middle meatal pathogenic bacteria were found to predict prolonged symptoms of upper respiratory infection, a randomized controlled trial is needed to evaluate the clinical value of middle meatal culture in identifying the children who would benefit from antimicrobial treatment during acute respiratory infection

Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial

Objective To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in children aged between 10 months and 2 years. Design Randomised, double blind, controlled trial. Setting Oulu University Hospital, a tertiary centre in Finland. Participants 180 children aged 10 months to 2 years with recurrent acute otitis media. Intervention Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitis media were recorded. Main outcome measures Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitis media, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions, and days with symptoms of respiratory infection. Results Compared with placebo, interventions failed during both the first six months and the rest of the follow up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups (at six months the differences in risk were 10% (95% confidence interval -9% to 29%) and 18% (-2% to 38%), respectively). No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. Conclusions Adenoidectomy, as the first surgical treatment of children aged 10 to 24 months with recurrent acute otitis media, is not effective in preventing further episodes. It cannot be recommended as the primary method of prophylaxis

Effect of topical antibiotics on duration of acute infective conjunctivitis in children:a randomized clinical trial and a systematic review and meta-analysis

Abstract Importance: Although topical antibiotics are often prescribed for treating acute infective conjunctivitis in children, their efficacy is uncertain. Objective: To assess the efficacy of topical antibiotic therapy for acute infective conjunctivitis. Design, Setting, and Participants: A randomized clinical trial was conducted in primary health care in Oulu, Finland, from October 15, 2014, to February 7, 2020. Children aged 6 months to 7 years with acute infective conjunctivitis were eligible for enrollment. The participants were followed up for 14 days. A subsequent meta-analysis included the present trial and 3 previous randomized clinical trials enrolling pediatric patients aged 1 month to 18 years with acute infective conjunctivitis. Interventions: Participants in the present randomized clinical trial were randomized to moxifloxacin eye drops, placebo eye drops, or no intervention. Main Outcomes and Measures: The primary outcome in the present randomized clinical trial was time to clinical cure (in days); in the meta-analysis, the primary outcome was the proportion of participants with conjunctival symptoms on days 3 to 6. Results: The randomized clinical trial included 88 participants (46 [52%] girls), of whom 30 were randomized to moxifloxacin eye drops (mean [SD] age, 2.8 [1.6] years), 27 to placebo eye drops (mean [SD], age 3.0 [1.3] years), and 31 to no intervention (mean [SD] age, 3.2 [1.8] years). The time to clinical cure was significantly shorter in the moxifloxacin eye drop group than in the no intervention group (3.8 vs 5.7 days; difference, −1.9 days; 95% CI, −3.7 to −0.1 days; P = .04), while in the survival analysis both moxifloxacin and placebo eye drops significantly shortened the time to clinical cure relative to no intervention. In the meta-analysis, a total of 584 children were randomized (300 to topical antibiotics and 284 to a placebo), and the use of topical antibiotics was associated with a significant reduction in the proportion of children who had symptoms of conjunctivitis on days 3 to 6 compared with placebo eye drops (odds ratio, 0.59; 95% CI, 0.39 to 0.91). Conclusions and Relevance: In this randomized clinical trial and systematic review and meta-analysis, topical antibiotics were associated with significantly shorter durations of conjunctival symptoms in children with acute infective conjunctivitis