S. pneumoniae predicts acute sinusitis microbial response

Research from the USA shows that confirmed nasopharyngeal colonization with Streptococcus pneumoniae independently predicts a rapid response to antimicrobial therapy in children with acute sinusitis.

“Because the nasopharynx is the reservoir from which pathogens enter the sinuses, it stands to reason that children with pathogens in their nasopharynx appear to benefit more from antimicrobial therapy,” comment study authors Nader Shaikh (University of Pittsburgh School of Medicine, Pennsylvania) and colleagues.

“This hypothesis is consistent with randomized, placebo-controlled trials of adults with acute sinusitis or upper respiratory tract infection that have shown antimicrobial therapy to be more effective in the subset of patients with nasopharyngeal colonization with respiratory pathogens.”

The team analyzed data on 198 children aged 2–12 years who presented in primary care with acute sinusitis and were prescribed antibiotics. The children completed the Pediatric Rhinosinusitis Symptom scale every evening until follow-up at 8–12 days.

Of the 150 children with nasopharyngeal cultures, 49% had at least one pathogen recovered; S.pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were isolated from 29%, 15%, and 15%, respectively.

The overall time to resolution of symptoms was 6–9 days in 19% of children, 10–19 days in 54%, and 20–30 days in 27%. The researchers found in multivariate analysis that confirmed nasopharyngeal colonization with S. pneumoniae at baseline was the only factor independently associated with time to resolution. The median time to resolution in such patients was 6.5 days compared with 8.5 days in children without colonization.

Other factors associated with time to resolution in univariate analysis included history of allergic rhinitis, headache, and a temperature over 38°C. However, these did not retain significance in the multivariate model.

Writing in the Journal of Pediatrics, Shaikh et al say that theirs is the first study to explore which factors predict symptom resolution in children with acute sinusitis.

“On the basis of our results, we recommend that authors of future randomized trials of children with acute sinusitis consider testing for respiratory pathogens... at the time of randomization. In this way, the efficacy of antimicrobials in these subgroups could be compared,” the team suggests.

“If substantial differences in efficacy are found, perhaps point-of-care test for S pneumoniae, could serve as a method of reducing prescription of antimicrobials.”

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