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Sponsors and Collaborators: |
University of Pittsburgh Thrasher Research Fund |
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Information provided by: | University of Pittsburgh |
ClinicalTrials.gov Identifier: | NCT00132275 |
Viral upper respiratory infections occur frequently during childhood (6-8 per year) and are, for the most part, self-limited episodes that resolve spontaneously and do not require antibiotic therapy. Acute otitis media and acute bacterial sinusitis are frequent complications of viral upper respiratory infections that will benefit from treatment with antibiotics. Acute bacterial sinusitis is one of the most common diagnoses in ambulatory practice and, in all age groups, accounts for an estimated 25 million physician office visits annually. It is essential to distinguish between patients who are experiencing uncomplicated viral upper respiratory infections and acute bacterial sinusitis to avoid the excessive use of antibiotics for patients who will not benefit from them. This is especially important now because of the escalation of antibiotic resistance among the bacteria that commonly cause acute bacterial sinusitis, acute otitis media and pneumonia. Inappropriate use of antibiotics is a major contributor to the problem of antimicrobial resistance - a problem which dramatically increases both the cost and complexity of treatment.
To improve the diagnosis and treatment of patients with acute bacterial sinusitis and reduce the inappropriate use of antibiotics, clinical guidelines have been developed by three national organizations: the American Academy of Pediatrics, the Sinus and Allergy Health Partnership and the Centers for Disease Control and Prevention. Traditionally, the diagnosis of acute bacterial sinusitis is suspected on the basis of clinical signs and symptoms and is confirmed with the performance of images (either plain radiographs, computed tomography or magnetic resonance imaging). All three guidelines recommend that the diagnosis and treatment of acute bacterial sinusitis should be based on clinical criteria alone without the confirmation of imaging or other laboratory data. Although the similarity between the different guidelines suggests that there is widespread consensus to use clinical criteria to diagnose acute bacterial sinusitis, there is virtually no evidence to support this position. Specific Aim 1 of this project is to evaluate the use of clinical criteria, without the performance of images, as the basis for the diagnosis of acute bacterial sinusitis. A randomized, placebo-controlled study design will be used to determine if the clinical criteria proposed by the different guidelines can be used to identify children with upper respiratory symptoms who will respond to antibiotic therapy. It is expected that children with acute bacterial sinusitis who receive an antimicrobial will recover more quickly and more often than children who receive placebo.
Condition | Intervention |
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Sinusitis |
Drug: Amoxicillin potassium clavulanate |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Efficacy Study |
Official Title: | Evaluation of National Guidelines for Acute Sinusitis |
Estimated Enrollment: | 240 |
Study Start Date: | November 2003 |
Study Completion Date: | August 2006 |
Ages Eligible for Study: | 1 Year to 10 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
A convenience sample of children between 1 and 10 years of age with one of three clinical presentations:
Exclusion Criteria:
Patients will be excluded if they have:
United States, Pennsylvania | |
University of Pittsburgh/Children's Hospital of Pittsburgh | |
Pittsburgh, Pennsylvania, United States, 15213 |
Principal Investigator: | Ellen R Wald, MD | University of Pittsburgh |
Study ID Numbers: | 1000928, Thrasher Award No 02818-4 |
Study First Received: | August 17, 2005 |
Last Updated: | May 19, 2008 |
ClinicalTrials.gov Identifier: | NCT00132275 |
Health Authority: | United States: Institutional Review Board |
bacterial sinusitis treatment |
diagnosis guideline acute bacterial sinusitis |
Amoxicillin Otorhinolaryngologic Diseases Respiratory Tract Infections Respiratory Tract Diseases |
Clavulanic Acid Clavulanic Acids Sinusitis |
Anti-Infective Agents Anti-Bacterial Agents Molecular Mechanisms of Pharmacological Action Paranasal Sinus Diseases |
Therapeutic Uses Enzyme Inhibitors Pharmacologic Actions Nose Diseases |