title: Efficacy of a stepwise protocol that includes intravenous antibiotic therapy for the management of chronic sinusitis in children and adolescents.
abstract: BACKGROUND
  Recent concern regarding interference with facial skeletal growth and the risk of complications after endoscopic sinus surgery (ESS) has led to interest in exploring other treatment options for the management of chronic sinusitis in children.
  
  
  OBJECTIVE
  To present the use of a stepwise protocol that includes intravenous (IV) antibiotic therapy as a therapeutic alternative to pediatric ESS.
  
  
  METHODS
  Retrospective analysis of pediatric patients with chronic sinusitis treated from January 1, 1993, to July 1, 1998, with a stepwise protocol that includes the use of IV antibiotics.
  
  
  METHODS
  Academic tertiary care children's hospital.
  
  
  METHODS
  Seventy patients, aged 10 months to 15 years, with the diagnosis of chronic sinusitis as defined by symptomatic disease for at least 12 weeks. All patients had persistent symptoms and radiographic evidence of sinus disease by computed tomographic scan after a minimum 3- to 4-week course of oral antibiotics.
  
  
  METHODS
  Patients were treated with maxillary sinus aspiration and irrigation with selective adenoidectomy, followed by a 1- to 4-week course of a culture-directed IV antibiotic. Most patients also underwent placement of a long-arm IV catheter.
  
  
  METHODS
  Medical charts were reviewed for clinical response to IV antibiotics, complications from IV antibiotic therapy, need for ESS, and recurrent episodes of sinusitis.
  
  
  RESULTS
  Of the 70 patients studied, 62 (89%) had complete resolution of symptoms following IV therapy with selective adenoidectomy. Eight patients (11%) failed IV therapy and required ESS. Thirty-seven patients (53%) underwent concurrent adenoidectomy. Patients treated with concurrent adenoidectomy had equivocal response rates compared with patients treated with IV antibiotic therapy alone. Follow-up data were available for 52 patients (range, 6-62 months; mean, 25 months). All recurrent episodes resolved with oral antibiotic therapy. Complications from IV therapy included superficial thrombophlebitis in 6 patients (9%) and dislodgement of a catheter guidewire during placement in 1 patient (1%), requiring venotomy. Antibiotic-related complications also occurred in 3 patients (4%) and included serum sickness, pseudomembranous colitis, and drug fevers.
  
  
  CONCLUSIONS
  A stepwise protocol that includes IV antibiotic therapy is a safe and efficacious mode of therapy for the management of chronic sinusitis in children and adolescents and may be a reasonable alternative to pediatric ESS.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave, Pittsburgh, PA 15213, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Don
authors.forename: R F
authors.initials: RF
authors.lastname: Yellon
authors.forename: M L
authors.initials: ML
authors.lastname: Casselbrant
authors.forename: C D
authors.initials: CD
authors.lastname: Bluestone
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D012189:Retrospective Studies; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents