What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review, Literature Review).

August 17, 2025

Management of acute sinusitis in children: an umbrella review

Key Points

Antibiotic use is supported in moderate to severe cases of acute sinusitis, while many mild cases resolve spontaneously without treatment.
Systematic reviews and clinical guidelines recommend adjuvant therapies like intranasal corticosteroids for modest symptom relief in children.
An Evidence Gap Map identified ongoing knowledge gaps in managing paediatric acute sinusitis, stressing a need for high-quality research.
Guidelines recommend careful diagnosis with high-dose amoxicillin-clavulanate and suggest watchful waiting for mild, uncomplicated cases.

Abstract

Abstract BACKGROUND. Acute sinusitis in children is a common disease, often secondary to upper respiratory viral infections, which can progress to bacterial infection. Although it is usually self-limiting, it can cause serious complications. The recommendations of clinical guidelines and systematic reviews are variable, which generates uncertainty regarding optimal management. OBJECTIVE. To synthesise the current evidence on the treatment of paediatric acute sinusitis through an umbrella review, identifying effective interventions, recommended guidelines, and knowledge gaps. MATERIAL AND METHODS. An umbrella review of systematic reviews, meta-analyses, and clinical guidelines published between 2000 and 2025 was conducted by searching five databases. PRISMA-Overviews criteria were applied, and methodological quality was assessed using AMSTAR-2. Descriptive synthesis, forest plot, funnel plot (Egger’s test) and an Evidence Gap Map (EGM) were used. RESULTS. Thirteen studies on paediatric acute sinusitis were included. High-quality evidence supported antibiotic use in moderate to severe cases, while mild cases often resolved without treatment. Adjuvant therapies like intranasal corticosteroids and saline irrigation showed modest symptom relief. Surgical interventions were necessary in orbital or intracranial complications, guided by clinical predictors. Guidelines emphasized strict diagnostic criteria, high-dose amoxicillin–clavulanate, and selective imaging. Watchful waiting was considered safe in mild, non-complicated cases with close follow-up. Overall, the evidence supports tailored management based on severity and clinical presentation. CONCLUSION. Not all children with acute sinusitis require antibiotics. Treatment should be individualized and the rational use of antimicrobials encouraged. Relevant evidence gaps persist that require further high-quality paediatric research.

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