Conclusions
At the pragmatic level, it would be useful to know whether the prescription of antibiotics as routine treatment for acute rhinosinusitis in children, irrespective of uncertainties as to the cause of sinus inflammation, is warranted in terms of safety and effectiveness. Our conclusion from this review would be that the evidence to support the routine use of antibiotics here remains unclear despite the positive findings of the statistical analysis. The evidence base is clearly inadequate and may be placed in the context of the larger systematic review reported for adult patients which does suggest some small benefit from the use of antibiotics. Future RCTs on this subject are faced with the difficulty of bringing further uniformity and accuracy to the application of diagnosis; this is a significant challenge as the introduction of any radiological or other diagnostic test is likely to detract from utility in primary care, yet diagnostic criteria that are too unrestrictive may lack the power of consistency between studies. Studies with more inclusive criteria are less likely to demonstrate antibiotic efficacy than those that favour the capture of participants with more severe symptoms. The authors would support current UK guidelines that promote a conservative approach to the treatment of acute rhinosinusitis in children with antibiotic prescribing only in selective cases.