Reason for withdrawal from publication
This review was withdrawn from The Cochrane Library, Issue 3, 2007. The authors agreed that they could no longer work towards completing the review, due to other work demands.
The editorial group responsible for this previously published document have withdrawn it from publication.
Keywords: Adolescent, Child, Humans, Anti‐Bacterial Agents, Anti‐Bacterial Agents/therapeutic use, Randomized Controlled Trials as Topic, Rhinitis, Rhinitis/drug therapy, Sinusitis, Sinusitis/drug therapy, Treatment Outcome
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Antibiotics for persistent nasal discharge
Summary
It is inappropriate to combine children with persistent nasal discharge for at least 10 days and children with radiographic signs of sinusitis.
First, persistent nasal discharge is not necessarilty purulent nasal discharge. Persistent clear rhinorrhea for greater than 10 days would not suggest sinusitis.
Second, although it may be ture that most children with radiographic signs of sinusitis have persistent nasal discharge (the explanation for combining these groups), the corollary has not been shown to be true. It has not been shown that most children with persistent nasal discharge have radiographic sinusitis.
In one study of 98 young adults with the common cold, 95% of those with a radiographic diagnosis of "sinusitis" on day seven + 77% of those without sinusitis had purulent rhinitis during days one through six. (J Allergy Clin Immunol 1998 Sep;102(3):403‐8) This study did not focus on children or persistent symptoms but does show that the common cold and viral infections can cause purulent rhinitis.
A previous Cochrane review has suggested that antibiotics are modestly effective for children with radiographically confirmed sinusitis. My interest in reading the current review was specifically for the much more common situation in practice ‐ the child with persistent nasal discharge in whom x‐rays have not been done. I was hoping to find results specific to this population.
Of the five trials included, four had radiographic inclusion criteria. The one trial that did not was limited to thirteen (13) children less than two years old with persistent nasal discharge for at least 10 days and not improving.
This is clearly too small of a sample to draw any conlcusions regarding antibiotic treatment for persistent nasal discharge as an isolated symptom.
The conclusion should be changed to reflect the lack of evidence regarding this population.
I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.
Contributors
Brian S. Alper M.D.
What's new
| Date | Event | Description |
|---|---|---|
| 13 December 2007 | Amended | Converted to new review format. |
History
Protocol first published: Issue 2, 1998 Review first published: Issue 3, 2000
| Date | Event | Description |
|---|---|---|
| 2 January 2006 | New citation required and conclusions have changed | Substantive amendment |
Sources of support
Internal sources
Menzies School of Health Research, Australia.
External sources
The National Health and Medical Research Council (Aboriginal Health Scholarship), Australia.
Acute Respiratory Infection Cochrane Review Group, Australia.
Withdrawn from publication for reasons stated in the review, comment added to review