According to a recent JAMA study by scientists at the University of Pittsburgh and UPMC, a nasal swab to screen for three types of bacteria can reveal whether or not antibiotics are likely to be beneficial in children with suspected sinusitis.
Five million kids in the US get prescribed antibiotics for sinusitis each year. Our study suggests that only half of these kids see an improvement in symptoms with antibiotic use, so by identifying who they are, we could greatly reduce unnecessary antibiotic use.
Nader Shaikh, MD, Study Lead Author and Professor, Pediatrics and Clinical and Translational Science, School of Medicine, University of Pittsburgh
Congestion, a runny nose, discomfort, and breathing problems are all symptoms of sinusitis, an inflammation or swelling of the sinuses. Even though the disease can be caused by viruses, doctors frequently recommend antibiotics—which exclusively treat bacterial infections—to treat it.
Shaikh added, “Sinusitis is one of the most common diseases we see in children, but it is difficult to diagnose because it is based on the duration of symptoms: If the child has a runny nose or congestion for more than 10 days, we suspect sinusitis. For an ear infection, we can look inside the ear; for pneumonia, we listen to the lungs. But for sinusitis, we have nothing to go on from a physical exam. That was very unsatisfying to me.”
Shaikh and his colleagues randomly allocated about 500 kids with sinusitis symptoms from six locations throughout the US to receive either a course of antibiotics or a placebo to better understand how to detect bacterial sinusitis.
The three primary types of bacteria associated with sinusitis were also detected using swabs taken from each child’s nose, much like a COVID-19 test.
Compared to children who did not contain the bacteria, those who tested positive for it had symptoms that responded better to antibiotic therapy. According to these results, microbial testing could be a quick and efficient technique to identify children who will benefit from antibiotics and prevent giving them to children who wouldn’t.
Shaikh further stated, “If antibiotics are not necessary, then why use them? These medications can have side effects, such as diarrhea, and alter the microbiome, which we still don’t understand the long-term implications of. Overuse of antibiotics can also encourage antibiotic resistance, which is an important public health threat.”
Shaikh claims that it is a widespread notion among parents and medical professionals that yellow or green snot is an indication of a bacterial infection.
Shaikh and his team formalized investigated this hypothesis by asking parents to identify the hue of their child’s snot on a color card, despite the fact that several minor studies have demonstrated that nasal discharge color is not important.
“If kids with green or yellow discharge benefitted more from antibiotics than those with clear-colored discharge, we would know that color is relevant for bacterial infection. But we found no difference, which means that color should not be used to guide medical decisions,” Shaikh added.
The researchers are examining the most effective way to use nasal testing in the clinic. The fact that the bacterial culture-based tests utilized in the study are complex for most family physicians to order and can take several days to get findings presents a significant obstacle.
Commercially available molecular testing, which can give answers right away, would be a more feasible strategy, according to Shaikh.
Another potential is the development of rapid antigen tests that function similarly to COVID-19 at-home testing kits. The researchers also intend to go further into the data from this study to discover whether there is another type of biomarker in nasal discharge that indicates the presence of bacteria that is simpler to detect.
Shaikh, N., et al. (2023). Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis. JAMA. doi.org/10.1001/jama.2023.10854