Bacterial testing in children with sinusitis could reduce antibiotic use

July 25, 2023

pittsburgh — In children with suspected sinusitis, nasal swabs that test for three types of bacteria can tell whether antibiotics are effective, according to a new study. Journal of the American Medical Association Study conducted by researchers at the University of Pittsburgh and UPMC.

“Five million children in the United States take antibiotics each year for sinusitis,” said lead author Nader Shaikh, MD, a pediatrician at UPMC Children’s Hospital of Pittsburgh and professor of pediatrics and clinical and translational sciences at the University of Pittsburgh. “Our research shows that only half of children improve their symptoms with antibiotics, so by identifying who they are we can significantly reduce unnecessary antibiotic use.”

Sinusitis is inflammation or swelling of the sinuses that can cause congestion, runny nose, discomfort, and difficulty breathing. Doctors often prescribe antibiotics (only for bacterial infections) to treat this condition, even though it may be caused by a virus.

“Sinusitis is one of the most common conditions we see in children, but it’s difficult to diagnose because it depends on the duration of symptoms: If a child has a runny or stuffy nose for more than 10 days, we suspect sinusitis,” Shaikh said. “With ear infections, we can look inside the ears; with pneumonia, we listen to the lungs. But with sinusitis, there’s nothing we can do with a physical exam. “That makes me very unsatisfied. “

To develop better tools for diagnosing bacterial sinusitis, Shaikh and his team recruited about 500 children with sinusitis symptoms from six centers in the United States and randomly assigned them to receive a course of antibiotics or a placebo. The researchers also took swabs from each child’s nasal cavity (much like a COVID-19 test) and tested for three main bacteria associated with sinusitis.

Children who tested positive for the bacteria experienced better symptom relief with antibiotic treatment than children who did not test for the bacteria. These findings suggest that bacterial testing may be a simple and effective way to detect children who may benefit from antibiotics and avoid prescribing antibiotics to those who will not.

“If antibiotics are not needed, why are they being used?” Sheikh said. “These drugs can cause side effects such as diarrhea and alter the microbiome, the long-term effects of which we still don’t understand. “Overuse of antibiotics also exacerbates antibiotic resistance, which is an important public health threat. “

Shaikh said parents and doctors generally believe that yellow or green nasal discharge is a sign of bacterial infection. Although some small studies have shown that snot colors don’t mean anything, Shaikh and his team formally tested the idea by asking parents to identify the color of their children’s snot on a color chart.

“If children with green or yellow discharge benefit more from antibiotics than those with clear-colored discharge, we know that color is associated with bacterial infection,” Sheikh explains. “But we found no difference, which means color should not be used to guide medical decisions.”

Researchers are now studying how best to conduct nasal testing in clinics. A major challenge is that the culture-based test used in the study is not easy for most family doctors to order, and can take several days to get results. A more practical approach may be commercial molecular tests, which can return results overnight, Sheikh said.

Another possibility is to develop rapid antigen tests similar to COVID-19 home test kits. The researchers also plan to dig deeper into the study’s data to see if there is another type of biomarker in nasal secretions that indicates the presence of bacteria that are easier to detect.

Other authors of the study include Alejandro Hoberman, MD, Timothy R. Shope, MD, Jong-Hyeon Jeong, MD, Marcia Kurs-Lasky, MD, Judith M. Martin, MD, Sonika Bhatnagar, MD, and Gysella B. Muniz, MD. (MD), Melissa Andrasko, RN, Matthew C. Lee, BA, and Kumaravel Rajakumar, MD, all from Pitt or UPMC; Stan L. Block, MD, Kentucky Pediatric/Adult Research Center ; and Ellen R. Wald, MD, University of Wisconsin.

This research was supported by the National Institute of Allergy and Infectious Diseases (U01AI118506).

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Photo details: (Click on image to view high-resolution version)

top photo
Image source: UPMC
Caption: Nader Shaikh, MD, pediatrician at UPMC Children’s Hospital of Pittsburgh and professor of pediatrics, clinical and translational sciences at the University of Pittsburgh

bottom photo
Image source: UPMC
Image caption: Nasal secretions color chart