Rachel Fieldhouse RESEARCH has confirmed that the colour

of nasal discharge when treating children with acute sinusitis is irrelevant , showing it has no impact on the effectiveness of antibiotic treatment .

While Australian and international sinusitis guidelines include purulent nasal discharge in diagnostic criteria , US paediatricians suggest it “ should not influence therapeutic decisions ”.

Their randomised trial included 510 children , aged 2-11 , with acute sinusitis but no history of allergic rhinitis or asthma who received either oral amoxycillin ( 90mg / kg / day ) and clavulanate ( 6.4mg / kg / day ) or placebo .

wait times for results and parents ’ willingness for their child to be swabbed — meant watchful waiting without antibiotics was also suitable .

“ Even though the 256 children who received placebo had less favourable symptom outcomes than children randomised to antibiotics , they never experienced a serious adverse event , rarely developed acute otitis media and 50 % had symptom resolution by day nine ,”

‘ You could have a yellow – green discharge but still no pathogen diagnosed .’

pathogen on the swab … and still have a clear discharge .”

But he said the suggested strategy of swabbing every child with a runny nose would be difficult to implement .

“ What a lot of people do not realise is , at the age of two , your sinuses are not well pneumatised yet , … so even the accuracy alone can be

challenging .”

Given the slight differences in outcomes , he added that the best treatment

Two-thirds of the cohort had

they wrote .

option would vary between patients .

coloured nasal discharge , and 71 %

Dr Eric Levi , a paediatric ENT sur-

“ If a child had other comorbidities

returned positive nasopharyngeal

geon and senior lecturer at the Univer-

or they were at risk of developing com-

swabs for Streptococcus pneumoniae , Haemophilus influenzae or Moraxella

Dr Eric Levi .

sity of Melbourne , said the findings challenged the widely held belief that

plications , taking a swab and starting antibiotics would be a safe and reason-

catarrhalis , but there was a “ weak ” cor-

nasal discharge colour was a reliable

able thing to do .

relation between the two variables .

did not differ based on the presence of

study suggest that a reasonable option

indicator of bacterial acute sinusitis .

“ If the parents are not keen on

Overall , the University of Pitts-

coloured nasal discharge .

to reduce antibiotic use in children

“ It is a dogma that tends to get

antibiotic therapy , there is also sup-

burgh – led team found that those

No serious adverse events were

with acute sinusitis would be to limit

taught over and over again : that green

port to say we can just wait it out and

treated with antibiotics had a lower

reported , and the incidence of non-se-

treatment to those colonised with

and yellow snot means that you have

watch it .”

symptom burden and recovered , on

rious adverse events was relatively low

pathogens in the nasopharynx at the

got bacterial [ infection ] and that clear

The study authors said the gener-

average , two days earlier than children

in both groups .

time of diagnosis ,” the authors wrote

[ discharge ] is most likely just viral or

alisability of the findings was limited

given placebo ( seven days vs nine days ,

However , twice as many children in

in the Journal of the American Medical

allergic rhinitis ,” said Dr Levi , who was

to children with similar symptoms and

respectively ). Children who tested pos-

the antibiotic group had clinically sig-

Association .

not involved in the study .

that those enrolled were more likely to

itive for the three pathogens of interest fared better with treatment than those without , but antibiotic efficacy

nificant diarrhoea compared with those in the placebo group ( 11 % vs 5 %).

“ The findings from the current

At the same time , they said the limitations of widespread pathogen testing for suspected sinusitis — including

“ You could have a yellow – green discharge but still no pathogen diagnosed on a swab , or you could have a positive

have coloured discharge and a higher symptom score . JAMA 2023 ; 25 Jul .