Objective A systematic review of randomised controlled trials reporting the efficacy of antibiotics compared with placebo in the treatment of acute rhinosinusitis in children.

Design Systematic review and meta-analysis.

Data sources Cochrane Register of Controlled Trials, Medline, Embase and references obtained from retrieved articles.

Results Four studies fitted the selection criteria for inclusion. Risks for internal bias were thought to be small for each study, but external bias is potentially significant. The pooled OR for symptom improvement at 10–14 days favouring the use of antibiotics was 2.0 (95% CI 1.16 to 3.47; I²=14.8%).

Conclusions While the meta-analysis provides evidence to support the use of antibiotics for acute rhinosinusitis in children, it is the assessment of this review that such efficacy has not been adequately demonstrated. There remains a clear methodological challenge in the examination of this important clinical question; this challenge relates to difficulties in the application of appropriate diagnostic and inclusion criteria which are also consistent between studies.