Nasal saline irrigation with or without systemic antibiotics in treatment of children with acute rhinosinusitis

Objectives: Acute rhinosinusitis (ARS) is a common pediatric problem. Our aim was to determine the efficacy of normal nasal saline irrigation (NSI) with or without amoxicillin in treatment of acute rhinosinusitis (ARS) in children. Methods: It is a prospective randomized, blind placebo-controlled trial. Children with uncomplicated ARS were recruited. One group received (amoxacillin 100 mg/kg/day) and 0.9% NSI. The second group received placebo and 0.9% NSI. The primary outcome was the effect of treatment on clinical response. Secondary outcomes included: Rating of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), middle meatus (MM) bacteriological and cytological cellular responses and adverse effects. Results: Sixty two patients with ARS were eligible for the study. In amoxicillin group (31 patients); clinical cure was observed in 26(83.9%) in comparison to 22 (71%) patients in NSI without antibiotics group (31 patients) (p = 0.22). No differences between both groups in the reported nasal symptom scores and total symptoms scores improvements at day 7 (p = 0.09 and 0.65) and day 14 (p = 0.29 and 0.14), respectively. The mean total PRQLQ values had no differences between both groups after the 2 weeks of treatment (p = 0.06). At day 7, MM neutrophils reduced significantly in amoxicillin group in comparison to placebo group (p = 0.004). At day 14, the MM cytological content had no differences between both groups (p = 0.07). Normal NSI with placebo has less reported adverse effects than amoxicillin and nasal saline irrigations (p = 0.005). Conclusions: NSI can be used alone with the same clinical, bacteriological and cytological cellular changes efficacy and with higher safety profile than amoxicillin after 14 days of treatment in uncomplicated clinically diagnosed ARS in children. (C) 2015 Elsevier Ireland Ltd. All rights reserved.