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WESTPORT, CT (Reuters Health) – A stepwise protocol that includes intravenous antibiotic therapy with selective adenoidectomy is a safe and effective form of treatment for children and adolescents with chronic sinusitis, according to a report in the September issue of the Archives of Otolaryngology–Head and Neck Surgery.

Optimal management of chronic sinusitis in pediatric patients is a controversial issue, the authors note. Endoscopic sinus surgery (ESS) is widely used, but recent concerns regarding its interference with facial skeletal growth and risk of complications have led to a search for other treatment options.

Dr. Charles D. Bluestone, from the University of Pittsburgh, and colleagues studied the use of a stepwise treatment protocol in 70 patients, 10 months to 15 years of age, with chronic sinusitis. They began with maxillary sinus aspiration and irrigation followed by adenoidectomy at the surgeon's discretion. Patients then received a 1- to 4-week course of culture-directed IV antibiotics. Most patients also had a long-arm IV catheter placed.

Except for eight patients who failed therapy and required ESS, all patients had complete resolution of symptoms, the researchers note. Thirty-seven patients underwent concurrent adenoidectomy and their response rates were equivocal compared with those of non-operative patients.

Analysis of data from 52 patients, followed for 25 months on average, revealed that oral antibiotic therapy successfully treated all recurrent episodes. Superficial thrombophlebitis was the most common IV therapy complication, occurring in 9% of patients. Four percent of patients experienced antibiotic-related complications.

The researchers point out that while the current findings are encouraging, the retrospective nature of the study does limit their meaning. Because no untreated group was included, it is hard to know the natural course of disease, they point out. In addition, because multiple treatments were applied to patients, it is difficult to ascertain individual treatment effects.

"Despite these deficiencies, this study suggests that a stepwise protocol that includes the use of IV antibiotic therapy is a safe and effective alternative to ESS for children and adolescents with chronic sinusitis," Dr. Bluestone and colleagues write.

In an accompanying editorial, Dr. Fuad M. Baroody, from the University of Chicago, comments that due to the study design, the current findings raise more questions than are answered.

"More information about the natural history of the disease, whether there are different host phenotypes, whether bacteria influence the host response, the role of vaccination, and data from more controlled studies addressing these issues would further our understanding of chronic sinusitis in the pediatric population," he notes.