Oral steroids added to antibiotics beneficial for chronic rhinosinusitis in children and adolescents

So many published studies spend large amounts of time and money to show tiny improvements in care and which have large NNT (number needed to treat to help one person). It is refreshing and important to note studies that unequivocally change the standard of care and dramatically improve outcomes.

In a randomized, double-blinded, controlled trial of treatment of chronic rhinosinusitis (lasting greater than 3 months), researchers in Turkey found that the rate of improvement and cure of disease roughly doubled (based on symptoms, and CT-scan followup) when systemic steroids (a 15-day taper) were added to antibiotic treatment (30 days) in children and adolescents. (Number needed to treat about 2; see link to reference, below).

In other studies, inhaled nasal corticosteroids are a cornerstone of treatment of chronic sinusitis; it would be interesting to compare nasal corticosteroids to systemic corticosteroids (both with oral antibiotics) head-to-head in children.

In adults, UpToDate® recommends systemic corticosteroids only in specific cases: unraveling puzzling cases, to reduce swelling in fungal sinusitis, and for reducing the size of polyps in adults with chronic sinusitis associated with nasal polyposis.

Robert Moore, MD, MPH

Reference

2 thoughts on “Oral steroids added to antibiotics beneficial for chronic rhinosinusitis in children and adolescents

    • Excellent question. Patients using nasal steroids were exclued from this study. In the discussion section, the authors said they wanted to first ascertain the effect of systemic steroids for this population (pediatric patients with non-polyposis chronic rhinosinusitis), since no double-blind placebo controlled studies on the use of steroids in this population had been performed. They then recommended that the next step should be a head-to-head comparison between systemic and topical steroids, a study which has not yet been performed. Certainly nasal steroids are commonly used in this clinical situation. Perhaps someone will do a study to compare the two forms of steroid administration.
      Richard Fleming, M.D.

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