title: Predicting response to antimicrobial therapy in children with acute sinusitis.
abstract: OBJECTIVE
  To determine prognostic factors that independently predict response to antimicrobial therapy in children with acute sinusitis.
  
  
  METHODS
  A total of 206 children meeting a priori clinical criteria for acute sinusitis who were prescribed antimicrobial therapy by their primary care provider were included. The severity of symptoms in the 8-12 days after treatment was initiated was followed with the use of a validated scale. We examined the univariate and multivariate association between factors present at the time of diagnosis (symptoms, signs, nasopharyngeal culture result, radiograph results) and time to resolution of symptoms. This study was conducted 8-10 years after the 7-valent pneumococcal conjugate vaccination was introduced but before introduction of the 13-valent pneumococcal conjugate vaccination.
  
  
  RESULTS
  Children with proven nasopharyngeal colonization with Streptococcus pneumoniae improved more rapidly (6.5 vs 8.5 median days to symptom resolution) than those who were not colonized with S pneumoniae. Age and radiograph findings did not predict time to symptom resolution.
  
  
  CONCLUSIONS
  In children with acute sinusitis, proven nasopharyngeal colonization with S pneumoniae at presentation independently predicted time to symptom resolution. Future randomized, placebo-controlled trials could investigate the usefulness of testing for the presence of nasopharyngeal pathogens as a predictor of response to treatment.
authors.affiliation: Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: nader.shaikh@chp.edu.
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Wald
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA.
authors.forename: Jong H
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
authors.affiliation: Division of Pediatric Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: A'delbert
authors.initials: A
authors.lastname: Bowen
authors.affiliation: Division of Pediatric Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Lynda L
authors.initials: LL
authors.lastname: Flom
authors.affiliation: Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
mesh_terms: D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D009305:Nasopharynx / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin