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Efficacy of a Stepwise Protocol That Includes Intravenous Antibiotic Therapy for the Management of Chronic Sinusitis in Children and Adolescents
Debra M. Don, MD;
Robert F. Yellon, MD;
Margaretha L. Casselbrant, MD, PhD;
Charles D. Bluestone, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1093-1098.
Background Recent concern regarding interference with facial skeletal growth and
the risk of complications after endoscopic sinus surgery (ESS) has led to
interest in exploring other treatment options for the management of chronic
sinusitis in children.
Objective To present the use of a stepwise protocol that includes intravenous
(IV) antibiotic therapy as a therapeutic alternative to pediatric ESS.
Design Retrospective analysis of pediatric patients with chronic sinusitis
treated from January 1, 1993, to July 1, 1998, with a stepwise protocol that
includes the use of IV antibiotics.
Setting Academic tertiary care children's hospital.
Patients Seventy patients, aged 10 months to 15 years, with the diagnosis of
chronic sinusitis as defined by symptomatic disease for at least 12 weeks.
All patients had persistent symptoms and radiographic evidence of sinus disease
by computed tomographic scan after a minimum 3- to 4-week course of oral antibiotics.
Interventions Patients were treated with maxillary sinus aspiration and irrigation
with selective adenoidectomy, followed by a 1- to 4-week course of a culture-directed
IV antibiotic. Most patients also underwent placement of a long-arm IV catheter.
Outcome Measures Medical charts were reviewed for clinical response to IV antibiotics,
complications from IV antibiotic therapy, need for ESS, and recurrent episodes
of sinusitis.
Results Of the 70 patients studied, 62 (89%) had complete resolution of symptoms
following IV therapy with selective adenoidectomy. Eight patients (11%) failed
IV therapy and required ESS. Thirty-seven patients (53%) underwent concurrent
adenoidectomy. Patients treated with concurrent adenoidectomy had equivocal
response rates compared with patients treated with IV antibiotic therapy alone.
Follow-up data were available for 52 patients (range, 6-62 months; mean, 25
months). All recurrent episodes resolved with oral antibiotic therapy. Complications
from IV therapy included superficial thrombophlebitis in 6 patients (9%) and
dislodgement of a catheter guidewire during placement in 1 patient (1%), requiring
venotomy. Antibiotic-related complications also occurred in 3 patients (4%)
and included serum sickness, pseudomembranous colitis, and drug fevers.
Conclusion A stepwise protocol that includes IV antibiotic therapy is a safe and
efficacious mode of therapy for the management of chronic sinusitis in children
and adolescents and may be a reasonable alternative to pediatric ESS.
From the Department of Pediatric Otolaryngology, Children's Hospital
of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Dr Don is now with the Division of Otolaryngology, Children's Hospital of
Los Angeles, Los Angeles, Calif.
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