Wan K S, Wu W F, Chen T C, Wu C S, Hung C W, Chang Y S
Department of Pediatrics, Taipei City Hospital, Renai Branch, Taiwan -
Minerva Pediatr. 2015 Dec;67(6):489-94.
Intranasal corticosteroids (INS) have been proven effective in controlling postnasal drip, decreasing inflammatory response, reducing nasal swelling, and increasing aeration of the sinuses such that INS are recommended as treatment of sinusitis.
Fifty children with acute rhinosinusitis, 50 children with acute rhiniosinusitis and allergic rhinitis (AR), and 20 rhiniosinusitis children as control were selected for investigation. Each group had a single-blind treatment of three types: with coamoxiclav only, with coamoxiclav plus INS, and with matched placebo (without antibiotics and INS) for two weeks. Nasal symptoms were then evaluated. The outcome was measured by using major symptom score (MSS) after treatment for 14 days.
Therapeutic effectiveness was 92% in rhinosinusitis patients treated with co-amoxiclav and 84% in those treated with co-amoxiclav plus INS. Among patients with sinusitis combined with AR, therapeutic efficacy was 88% for those treated with co-amoxiclav and 96% for those treated with co-amoxiclav plus INS. Only 30% of the symptoms were reduced in the placebo group.
There are no statistical differences in the acute sinusitis group treated with co-amoxiclav with or without INS. In the sinusitis with AR group, the efficacy of co-amoxiclav with INS is higher than in children treated with co-amoxiclav alone.
鼻内用糖皮质激素（INS）已被证明在控制鼻后滴漏、减轻炎症反应、减轻鼻肿胀以及增加鼻窦通气方面有效，因此INS被推荐用于治疗鼻窦炎。
选取50例急性鼻-鼻窦炎患儿、50例急性鼻-鼻窦炎合并变应性鼻炎（AR）患儿以及20例鼻-鼻窦炎患儿作为对照进行研究。每组采用三种类型的单盲治疗：仅使用阿莫西林克拉维酸、使用阿莫西林克拉维酸加INS以及使用匹配的安慰剂（不含抗生素和INS）治疗两周。然后评估鼻部症状。治疗14天后使用主要症状评分（MSS）来衡量结果。
用阿莫西林克拉维酸治疗的鼻-鼻窦炎患者的治疗有效率为92%，用阿莫西林克拉维酸加INS治疗的患者为84%。在鼻窦炎合并AR患者中，用阿莫西林克拉维酸治疗的患者治疗有效率为88%，用阿莫西林克拉维酸加INS治疗的患者为96%。安慰剂组仅有30%的症状得到减轻。
在使用或不使用INS的阿莫西林克拉维酸治疗的急性鼻窦炎组中无统计学差异。在鼻窦炎合并AR组中，阿莫西林克拉维酸加INS的疗效高于仅用阿莫西林克拉维酸治疗的儿童。
