Azithromycin: 3-Day Versus 5-Day Course in the Treatment of Respiratory Tract Infections in Children

Ficnar, B; Huzjak, Nevenka; Oreskovic, K.; Matrapazovski, Mirjana; Klinar, I

doi:10.1179/joc.1997.9.1.38

Cited by 126 publications

(21 citation statements)

References 3 publications

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“…Two small, randomized trials have evaluated short courses of antibacterials in children. Ficnar et al [39] compared 3 versus 5 days of azithromycin and Ng et al [40] compared 3 days of azithromycin versus 14 days amoxicillin/clavulanate. Acknowledging the small sample size of these trials, no difference in efficacy between short and long courses of the tested antibacterials was demonstrated.…”

Section: Short Courses Of Antibioticsmentioning

confidence: 98%

Treatment options for acute sinusitis in children

Contopoulos‐Ioannidis

Ioannidis

2004

Curr Allergy Asthma Rep

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Much controversy exists regarding the best diagnostic method for acute sinusitis, the efficacy of antibiotics, the best choice of antibiotics, the most appropriate duration of therapy, and the efficacy of ancillary measures and nasal corticosteroids. The therapeutic goal is to identify those children who are more likely to have bacterial sinusitis and unlikely to resolve spontaneously, who may require treatment with antibiotics. The inaccuracy of clinical signs and symptoms complicates further the management of these children. Acute sinusitis is expected to resolve spontaneously in most cases, including many cases of bacterial sinusitis. Antibiotics are needed only for a minority of non-self-resolving infections. Based on current resistance considerations, approximately 80% of bacterial infections are expected to respond to standard doses of amoxicillin. High-dose amoxicillin, amoxicillin/clavulanate, or other b-lactam antibiotics should be considered for children at high risk for carrying resistant organisms. Evidence for the effectiveness of ancillary measures is limited.

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Section: Short Courses Of Antibioticsmentioning

confidence: 98%

Treatment options for acute sinusitis in children

Contopoulos‐Ioannidis

Ioannidis

2004

Curr Allergy Asthma Rep

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“…[12][13][14][15][16] Three of these were included in the previous report, and 2 additional studies have been published since 1998. None of these studies demonstrated a clear advantage of 1 therapy over another, and rates of cure or improvement were well above 80%.…”

Section: Randomized Controlled Comparison Trialsmentioning

confidence: 99%

“…12,[14][15][16] The incidence of CF, cystic fibrosis; GAS, group A streptococcal; IV, intravenous; NA, not applicable; NP, nasopharyngeal; Rx, prescription; US, ultrasonography. …”

Section: Randomized Controlled Comparison Trialsmentioning

confidence: 99%

Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Review

Smith¹

2013

Pediatrics

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In 2001, the American Academy of Pediatrics published clinical practice guidelines for the management of acute bacterial sinusitis (ABS) in children. The technical report accompanying those guidelines included 21 studies that assessed the diagnosis and management of ABS in children. This update to that report incorporates studies of pediatric ABS that have been performed since 2001. Overall, 17 randomized controlled trials of the treatment of sinusitis in children were identified and analyzed. Four randomized, double-blind, placebo-controlled trials of antimicrobial therapy have been published. The results of these studies varied, likely due to differences in inclusion and exclusion criteria. Because of this heterogeneity, formal meta-analyses were not performed. However, qualitative analysis of these studies suggests that children with greater severity of illness at presentation are more likely to benefit from antimicrobial therapy. An additional 5 trials compared different antimicrobial therapies but did not include placebo groups. Six trials assessed a variety of ancillary treatments for ABS in children, and 3 focused on subacute sinusitis. Although the number of pediatric trials has increased since 2001, there are still limited data to guide the diagnosis and management of ABS in children. Diagnostic and treatment guidelines focusing on severity of illness at the time of presentation have the potential to identify those children most likely to benefit from antimicrobial therapy and at the same time minimize unnecessary use of antibiotics.

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“…Bacteriologic response with sinus aspirates obtained before and after treatment was assessed only in 2 studies. In the study by Ficnar et al, 10 eradication was achieved with azithromycin in 3 of 3 patients who had isolated pathogens. Puhakka et al 23 used sinus aspirates and exudates from sinus ostia for culture; information on the 2 sampling modes is not presented separately.…”

Section: Efficacy Of Antibiotic Interventionsmentioning

confidence: 99%

“…The 2 shorter courses (3 and 5 days) were with azithromycin, which retains high drug levels for several days after its discontinuation. 10 All other studies used at least 7 days of therapy. Decongestants were either reported to be routinely prescribed or their use was not mentioned at all.…”

Section: Efficacy Of Antibiotic Interventionsmentioning

confidence: 99%

Technical Report: Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Overview

Ioannidis

Lau

2001

Pediatrics

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ABSTRACT.Objective. To evaluate and analyze the existing evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children.Design. A systematic overview and meta-analysis considered all pertinent studies with at least 10 children younger than 18 years with acute symptoms of <30 days and without serious complications.Outcomes. Clinical improvement rates for intervention studies of antibiotics or ancillary measures; concordance of diagnostic tests (expressed as likelihood ratios).Results. Of 1857 citations originally reviewed, we identified 21 qualifying studies, compared with 450 reports on complications of acute sinusitis and 233 nonsystematic reviews of the subject. The qualifying studies included 5 randomized, controlled trials and 8 case series on antibiotic therapy, 3 randomized, controlled trials on ancillary treatments, and 8 studies with information on diagnostic tests (including 3 therapeutic trials). Definitions and inclusion criteria were heterogeneous across studies. The pooled clinical improvement rate with antibiotics was 88% (177/202) in randomized, controlled trials and 92% (318/345) in nonrandomized studies; the improvement rates on no antibiotics were 60% and 80%, respectively. Improvement rates were significantly higher in nonrandomized studies (Mantel-Haenszel odds ratio: 1.79; 95% CI: 1.05-3.04, stratified for use of antibiotics). Data on ancillary measures were sparse and heterogeneous. In studies comparing clinical findings with plain film radiography, the pooled rate of abnormal radiographic findings against a clinical diagnosis of sinusitis was 73% (596/814; range: 55% to 96% between studies). There was poor concordance between clinical criteria, plain radiographs, ultrasonography, computed tomography, and fluid on aspiration in all available paired assessments (all positive likelihood ratios were <4 and all negative likelihood ratios were >0.2).Conclusions. Good, high-quality evidence for acute uncomplicated sinusitis in children is limited. Diagnostic modalities show poor concordance, and treatment options are based on inadequate data. More evidence is needed for defining the optimal treatment and diagnostic methods for this common condition.

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Azithromycin: 3-Day Versus 5-Day Course in the Treatment of Respiratory Tract Infections in Children

Cited by 126 publications

References 3 publications

Treatment options for acute sinusitis in children

Treatment options for acute sinusitis in children

Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Review

Technical Report: Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Overview

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