title: Nasal saline irrigation with or without systemic antibiotics in treatment of children with acute rhinosinusitis.
abstract: OBJECTIVE
  Acute rhinosinusitis (ARS) is a common pediatric problem. Our aim was to determine the efficacy of normal nasal saline irrigation (NSI) with or without amoxicillin in treatment of acute rhinosinusitis (ARS) in children.
  
  
  METHODS
  It is a prospective randomized, blind placebo-controlled trial. Children with uncomplicated ARS were recruited. One group received (amoxacillin 100mg/kg/day) and 0.9% NSI. The second group received placebo and 0.9% NSI. The primary outcome was the effect of treatment on clinical response. Secondary outcomes included: Rating of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), middle meatus (MM) bacteriological and cytological cellular responses and adverse effects.
  
  
  RESULTS
  Sixty two patients with ARS were eligible for the study. In amoxicillin group (31 patients); clinical cure was observed in 26 (83.9%) in comparison to 22 (71%) patients in NSI without antibiotics group (31 patients) (p=0.22). No differences between both groups in the reported nasal symptom scores and total symptoms scores improvements at day 7 (p=0.09 and 0.65) and day 14 (p=0.29 and 0.14), respectively. The mean total PRQLQ values had no differences between both groups after the 2 weeks of treatment (p=0.06). At day 7, MM neutrophils reduced significantly in amoxicillin group in comparison to placebo group (p=0.004). At day 14, the MM cytological content had no differences between both groups (p=0.07). Normal NSI with placebo has less reported adverse effects than amoxicillin and nasal saline irrigations (p=0.005).
  
  
  CONCLUSIONS
  NSI can be used alone with the same clinical, bacteriological and cytological cellular changes efficacy and with higher safety profile than amoxicillin after 14 days of treatment in uncomplicated clinically diagnosed ARS in children.
authors.affiliation: Department of Otorhinolaryngology, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt. Electronic address: drahmedragab@med.menofia.edu.eg.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ragab
authors.affiliation: Department of Pathology, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt.
authors.forename: Taghreed
authors.initials: T
authors.lastname: Farahat
authors.affiliation: Department of Family Medicine, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt.
authors.forename: Ghada
authors.initials: G
authors.lastname: Al-Hendawy
authors.affiliation: Department of Microbiology, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt.
authors.forename: Rehab
authors.initials: R
authors.lastname: Samaka
authors.affiliation: Department of Pediatrics, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt.
authors.forename: Seham
authors.initials: S
authors.lastname: Ragab
authors.affiliation: Department of Family Medicine, Menoufia University Hospital, Gamal Abd El-Nasir, Shebeen El-Kom, Menoufia Governorate, Egypt.
authors.forename: Amira
authors.initials: A
authors.lastname: El-Ghobashy
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055556:Nasal Lavage; D009504:Neutrophils / Q000378:metabolism; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000382:microbiology / Q000628:therapy*; D012852:Sinusitis / Q000382:microbiology / Q000628:therapy*; D012965:Sodium Chloride
chemical_list: D000900:Anti-Bacterial Agents; D012965:Sodium Chloride; D000658:Amoxicillin
keywords: Acute rhinosinusitis; Amoxicillin; Nasal saline irrigation; Randomized controlled trial; Sinusitis treatment