Acute bacterial sinusitis in children: an updated review

Antibiotics for Acute Sinusitis in Children: A Meta-Analysis

CONTEXT

Acute sinusitis is one of the leading causes of antibiotic prescriptions in children. No recent systematic reviews have examined the efficacy of antibiotics compared with placebo.

OBJECTIVE

We sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.

DATA SOURCES

Medline and Embase were searched from their origin to July 2023.

STUDY SELECTION

We considered randomized placebo-controlled studies focusing on the treatment of acute sinusitis. In all studies, symptoms were present for <4 weeks and subjects were <18 years of age.

DATA EXTRACTION

Two authors independently extracted the data. We pooled data primarily using fixed-effects models.

RESULTS

Analysis of 6 included studies showed that antibiotic treatment reduced the rate of treatment failure by 41% (with a risk ratio of 0.59; 95% confidence interval 0.49-0.72) compared with placebo. There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%). Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62, 95% confidence interval 1.04-2.51).

LIMITATIONS

A small number of studies were eligible for inclusion. Included studies differed in their methodology.

CONCLUSIONS

In children with clinically diagnosed acute sinusitis, antibiotics significantly reduced the rate of treatment failure compared with placebo. However, given the favorable natural history of sinusitis, our results could also support close observation without immediate antibiotic treatment.

Comparison of visual diagnostic accuracy of dermatologists practicing in Germany in patients with light skin and skin of color

Visual clinical diagnosis of dermatoses in people of color (PoC) is a considerable challenge in daily clinical practice and a potential cause of misdiagnosis in this patient cohort. The study aimed to determine the difference in visual diagnostic skills of dermatologists practicing in Germany in patients with light skin (Ls) and patients with skin of color (SoC) to identify a potential need for further education. From April to June 2023, German dermatologists were invited to complete an online survey with 24 patient photographs depicting 12 skin diseases on both Ls and SoC. The study's primary outcomes were the number of correctly rated photographs and the participants' self-assessed certainty about the suspected visual diagnosis in Ls compared to SoC. The final analysis included surveys from a total of 129 dermatologists (47.8% female, mean age: 39.5 years). Participants were significantly more likely to correctly identify skin diseases by visual diagnostics in patients with Ls than in patients with SoC (72.1% vs. 52.8%, p ≤ 0.001, OR 2.28). Additionally, they expressed higher confidence in their diagnoses for Ls than for SoC (73.9 vs. 61.7, p ≤ 0.001). Therefore, further specialized training seems necessary to improve clinical care of dermatologic patients with SoC.

Pediatric Odontogenic Sinusitis: A Systematic Review

Background: Pediatric odontogenic sinusitis (PODS) is a rare condition with limited research on its clinical features, diagnostic criteria, and treatment options. The current guidelines on pediatric rhinosinusitis do not mention a possible dental origin of the disease. This systematic review aims to summarize and analyze the existing literature on PODS, focusing on epidemiology, etiology, diagnostic tools, complications, treatment options, and outcomes. Methods: A systematic review was conducted following PRISMA reporting guidelines. Electronic searches were performed in multiple databases using keywords related to PODS and therapeutic strategies. Original articles reporting data on treatment outcomes for PODS were included. Results: The review highlighted the scarcity of high-quality evidence on PODS. The literature mainly consists of case reports and low-grade evidence studies. Limited data on the epidemiology, etiology, diagnostic tools, complications, and treatment outcomes of PODS in children are available. Conclusions: Further research is needed to better understand the clinical features, diagnosis, and treatment of PODS in pediatric patients. High-quality studies are required to establish evidence-based guidelines for the management of this condition, especially given the apparently high rate of complications when compared to adult ODS.

Nasopharyngeal metatranscriptomics reveals host-pathogen signatures of pediatric sinusitis

Acute sinusitis (AS) is the fifth leading cause of antibiotic prescriptions in children. Distinguishing bacterial AS from common viral upper respiratory infections in children is crucial to prevent unnecessary antibiotic use but is challenging with current diagnostic methods. Despite its speed and cost, untargeted RNA sequencing of clinical samples from children with suspected AS has the potential to overcome several limitations of other methods. However, the utility of sequencing-based approaches in analysis of AS has not been fully explored. Here, we performed RNA-seq of nasopharyngeal samples from 221 children with clinically diagnosed AS to characterize their pathogen and host-response profiles. Results from RNA-seq were compared with those obtained using culture for three common bacterial pathogens and qRT-PCR for 12 respiratory viruses. Metatranscriptomic pathogen detection showed high concordance with culture or qRT-PCR, showing 87%/81% sensitivity (sens) / specificity (spec) for detecting bacteria, and 86%/92% (sens/spec) for viruses, respectively. We also detected an additional 22 pathogens not tested for in the clinical panel, and identified plausible pathogens in 11/19 (58%) of cases where no organism was detected by culture or qRT-PCR. We assembled genomes of 205 viruses across the samples including novel strains of coronaviruses, respiratory syncytial virus (RSV), and enterovirus D68. By analyzing host gene expression, we identified host-response signatures that distinguished bacterial and viral infections and correlated with pathogen abundance. Ultimately, our study demonstrates the potential of untargeted metatranscriptomics for in depth analysis of the etiology of AS, comprehensive host-response profiling, and using these together to work towards optimized patient care.

Temporal Trends in Pediatric Acute Sinusitis Surrounding the COVID-19 Pandemic

OBJECTIVE

We assessed patterns in the national incidence of pediatric acute sinusitis and associated complications surrounding the initial COVID-19 lockdown.

STUDY DESIGN

Retrospective National Database review.

SETTING

The Pediatric Health Information System.

METHODS

Acute sinusitis and associated complication incidence data from 2015 to 2022 were queried. Three time periods of T1, T2, and T3 were defined as: pre-COVID-19 baseline, initial pandemic, and postpandemic. Statistical analysis included Wilcoxon rank sum tests, multivariable logistic regressions, and autoregressive integrated moving averages (ARIMA) to assess differences between the observed complication rates in T2 and T3 and the expected incidence rates in these time periods as estimated from T1 data.

RESULTS

We identified 2535 acute sinusitis admissions across 42 centers. The incidence differed between T1 (31.5 cases/month), T2 (15.8 cases/month), and T3 (29 cases/month). Children aged 10 to 14 years had the highest acute sinusitis incidence rate (32.5%) compared to other ages in T2. At T1, acute sinusitis and associated complication rates followed parallel seasonal patterns. Although sinusitis incidence decreased during T2, complications increased significantly during T2 and T3 compared to T1 (37.4% and 39% vs 27.5%, P < .001). In the ARIMA model, the ratio of the observed to expected incidence (95% confidence interval) of complications was 1.09 (0.69, 2.60) in T2 and 1.14 (0.73, 2.62) in T3.

CONCLUSION

We report the simultaneous decrease in acute sinusitis incidence and an increase in associated complications during and after the initial COVID-19 pandemic compared to the prepandemic baseline, reflecting changing patterns in viral infection due to the pandemic.

Innovating Online Otolaryngology: The Development of the ENT Content Engagement and Quality Index for Audiovisual Material

Introduction The advent of social media platforms, notably TikTok, has significantly transformed the landscape of health information dissemination, offering both opportunities and challenges for public health communication. This study focuses on TikTok's influence on sinus health information, addressing the dual challenge of widespread engagement and the risk of misinformation in otolaryngology, or ENT (ear-nose-throat), information online. We introduce the ENT Content Engagement and Quality Index (ENT-CEQI), a pioneering tool designed to assess the quality and engagement of ENT-related content on TikTok, aiming to improve public understanding of sinus health. Materials and methods Our methodology involved a systematic analysis of sinus health-related content on TikTok. We collected data on the top 100 most popular videos using the hashtag #sinus at two different points in time, analyzing engagement metrics and content quality. The ENT-CEQI was developed to evaluate content, incorporating both quantitative engagement metrics (views, likes, comments, shares, favorites) and qualitative assessments (accuracy, clarity, relevance, practicality, engagement). The study employed statistical analyses, including trend analysis, correlation analysis, principal component analysis (PCA), KMeans clustering, regression analysis, and the Kruskal-Wallis test, to understand the dynamics of content engagement and quality. Results Initial findings revealed significant disparities in engagement metrics and quality scores among different content creator categories, with physician-generated content showing the highest engagement and quality. The trend analysis indicated shifts in content popularity and quality over time, with a notable increase in views and likes for private company content. The PCA and clustering analyses identified distinct content clusters, offering insights into viewer engagement patterns. Regression analysis and the Kruskal-Wallis test, however, did not find significant predictors (p-value: 0.3916) of content quality or differences in likes across content types, suggesting complex factors influencing content engagement and quality perception. Discussion The study highlights TikTok's potential and pitfalls in disseminating sinus health information. The introduction of the ENT-CEQI represents a major step toward enhancing the evaluation of health content on social media, emphasizing the importance of accuracy, clarity, and relevance in public health communication. The analysis underscores the complexity of social media engagement and the need for robust tools to assess content quality. It also points to the critical role of healthcare professionals in engaging with the public through social media to combat misinformation. Conclusions TikTok serves as a potent platform for sinus health education, capable of reaching wide and diverse audiences. The ENT-CEQI emerges as a vital tool for assessing the quality and engagement of ENT-related content, guiding content creators toward producing more reliable and informative content. This study contributes to the understanding of social media's role in health communication, advocating for the strategic use of innovative tools such as the ENT-CEQI to enhance public health outcomes through improved online health education and misinformation management.

A clinical prevalence of dermatophytic mycoses with an assessment of its clinical manifestations in a tertiary care hospital at Salem, South India

BACKGROUND

Dermatophytosis is very common among all age groups throughout the world. The incidence of the same is increasing on a steady basis.

AIM

Estimating the clinical prevalence of dermatophytes mycoses among the patients visiting the outpatient unit and assessing its distinct manifestations.

METHODOLOGY

A prospective observational study was conducted with the patients attending the Skin and STD outpatient unit of a tertiary care teaching hospital in Salem. A total of 3068 outpatients attended the department, of which 420 patients were diagnosed with dermatophytic mycoses and were taken for investigating the prevalence.

RESULTS

A total of 420 dermatophytosis patients were included giving a percentage prevalence of 13.69%. There were more female patients (n = 213, 50.71%) than males (n = 207, 49.29%). The most common afflicted age group was 31-40 years (n = 99, 50.71%). Most of the patients had an atypical lesion called tinea incognita (n = 265, 63.09%) where there was no typical classic appearance of dermatophytic infections. The most prevalent clinical manifestation was tinea corporis (n = 73, 17.38%) followed by tinea cruris (n = 69, 16.43%). There were more newly diagnosed dermatophytosis cases (n = 326) than the previously diagnosed cases (n = 94).

CONCLUSION

This study concludes that dermatophytic mycoses were more prevalent among females than males and among the age groups of 31-40 years. The most common clinical presentation was tinea incognita followed by tinea corporis.

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of 'Watch' antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.

A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.

Antibiotic prescriptions for child sinusitis varied between specialties after Finnish guidelines were updated in 2018

AIM

We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014-2020. Data were compared before and after updated guidelines in 2018.

METHODS

The study comprised data on 45 296 children aged 2-17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin-clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus.

RESULTS

There were 6621-7585 visits per year for acute sinusitis in 2014-2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%-41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin-clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014-2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians.

CONCLUSION

Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014-2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines.

COVID-19 Co-Infection May Promote Development of Sinusitis Complication in Children

BACKGROUND

The olfactory dysfunction that occurs during a COVID-19 infection has sparked much debate about its similarity to sinusitis. Up to 65% of COVID-19 pediatric patients may be asymptomatic; however, when symptoms are observed, fever and cough are the most common. Nasal congestion and discharge as well as headaches can also be seen, which makes both entities, i.e., COVID-19 and sinusitis, similar to each other.

METHODS

In this review, we present the clinical case of a teenager with a history of acute sinusitis and COVID-19 co-infection followed by purulent meningoencephalitis. We aim to summarize available findings on the association between COVID-19, sinusitis, and possible common complications of both diseases.

RESULTS

Differentiating between COVID-19 and sinusitis can be confusing because presented symptoms may overlap or mimic each other. Increased risk of complications, especially in patients with bacterial sinusitis co-infected with SARS-CoV-2, should prompt physicians to monitor young patients and inform parents about disturbing symptoms and possible complications.

CONCLUSIONS

Acute sinusitis and COVID-19 co-infection may lead to numerous complications and should be included among the factors predisposing to worse prognosis. It is especially related to patients with high risk factors and even more important in children as they often pass the infection asymptomatically and its complications can lead to loss of health or life.

Antibiotic stewardship programmes had a low impact on prescribing for acute respiratory tract infections in children

Aim

This mini review summarises the available data on antibiotic stewardship programmes (ASP) for acute respiratory tract infections (ARTI) in paediatric outpatients, particularly the implementation and impact of programmes.

Methods

PubMed was searched from 1 January 2012 to 31 December 2021 for papers with abstracts that used the terms respiratory tract infection, antibiotic, child and guideline. We then saw how many of these included the individual terms impact, implementation or stewardship. After exclusions, we included 10 papers that were published in English on children treated as outpatients for ARTIs. All of these included data on implementing and assessing the impact of ASPs.

Results

The primary care data were mainly from the United States. The ASP programmes did not influence antibiotic prescription rates, but broad‐spectrum antibiotics decreased by 43–48%. The emergency department data were mainly from France and the antibiotic prescription rate decreased by 31–35% and the rate for broad‐spectrum antibiotics by 63–71%. A nationwide register‐based study from France confirmed these results.

Conclusion

ASPs had a low impact on overall antibiotic prescription rates and a modest impact on prescribing broad‐spectrum antibiotics. The implementation of ASP protocols needs further development, and more research is necessary on barriers to complying with ASPs.

COVID-19 in patients with systemic lupus erythematosus: A systematic review

The objectives of the study were to review the articles to identify (a) the epidemiology of systemic lupus erythematosus (SLE) and coronavirus disease 2019 (COVID-19); (b) the clinical characteristics of SLE patients with COVID-19; (c) the treatment of COVID-19 in SLE patients; and (d) the impact of COVID-19 pandemic on SLE patients. PubMed was systematically reviewed for literature published from December 2019 to June 2021. Our search was limited to human studies, with language restriction of English. Studies were included if they reported COVID-19 in SLE patients. Our systematic review included 52 studies. The prevalence of COVID-19 infection ranged from 0.0% to 18.1% in SLE patients, and the hospitalisation rates ranged from 0.24% to 10.6%. COVID-19 infection is likely to mimic SLE flare. Hydroxychloroquine (HCQ) was ineffective in prevention of COVID-19, and SLE patients with COVID-19 faced difficulty in healthcare access, had financial constraints and suffered from psychological distress during the pandemic. The pandemic had a significant effect on mental and physical health. Adequate healthcare access, along with containment policies, social distancing measures and psychological nursing was required.