1085 DIAGNOSIS AND TREATMENT OF PURULENT NASOPHARYNGITIS – A DOUBLE-BLIND, TWO-DRUG EVALUATION

Todd, James; Todd, Nancy; Damato, James; Todd, Warren; Kempe, C Henry

132 children with purulent nasopharyngitis and no other indication for specific treatment had gram stain and bacterial culture of nasopharyngeal discharge and were randomized to 4 treatment groups with antibiotic (A=cephalexin) or decongestant/anti-histamine (D=pseudoephedrine/triprolidine) or their corresponding placebo equivalents (A+D+, A+D−, A−D+, A−D−). Follow-up parent, physician, and bacteriologic evaluations were performed after 5 days of therapy without knowledge of active drug status. Groups were comparable for age, sex, race, number of patients withdrawn from study, days ill, fever >38.0 C, appearance of discharge, nasal crusting, and number of days until follow-up. 21% of patients grew H. influenzae type b and only 8% S. pyogenes on initial culture. Nasal crusting was significantly (p<0.01) associated with the growth of S. pneumoniae or H. influenzae type b, suggesting a possible pathologic relationship. There were, however, no significant differences between active drug and placebo treatment groups for change in nasal discharge, complications, apparent drug benefit, or change in nasal flora with active antibiotic treatment. Significantly (p<0.05) more side effects were attributed to the D+ treatment groups. Routine culture and/or treatment of purulent nasopharyngitis cannot be recommended unless properly controlled studies demonstrate a significant drug benefit.