Aurélie Cabaillot1, Philippe Vorilhon2, Mathieu Roca3, Rémy Boussageon4, Bénédicte Eschalier5, Bruno Pereirad6. 1. Department of General Medicine, Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, France; Clermont Auvergne University, Inserm 1107, Neuro-Dol, Observatoire Français des Médicaments Antalgiques (OFMA), 63001 Clermont Ferrand, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. Electronic address: aurelie.cabaillot@uca.fr. 2. Department of General Medicine, Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, France; Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F 63000 Clermont-Ferrand, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. Electronic address: philippe.vorilhon@uca.fr. 3. Department of General Medicine, Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. 4. Department of General Medicine, Faculty of Medicine of Poitiers, Université de Poitiers, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. Electronic address: remy.boussageon2@wanadoo.fr. 5. Department of General Medicine, Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, France; Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F 63000 Clermont-Ferrand, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. Electronic address: benedicte.eschalier@udamail.fr. 6. Department of General Medicine, Faculty of Medicine of Poitiers, Université de Poitiers, France; University Hospital Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Department), 58 Rue Montalembert, 63000 Clermont Ferrand, France. Electronic address: bpereira@chu-clermontferrand.fr.
Abstract
PURPOSE: Acute upper respiratory tract infections are the most common infections in infants and children. Saline nasal irrigation (SNI) is widely prescribed and recommended. We conducted a systematic review to assess the efficacy and safety of SNI in infants and children with acute rhinopharyngitis. METHODS: We searched CENTRAL, Medline, Embase and clinicalTrials.gov. Two authors selected randomized control trials (RCTs), including infants ≥3 months and children ≤12 years, comparing the use of isotonic saline solutions, whatever their mode of administration, with one therapeutic abstention, or a therapy deemed less important for nasal lavage. Trial quality was assessed independently by two authors, who, with a third author, extracted and analysed data. Statistical analysis was conducted using Comprehensive Meta-Analysis software. The standard difference in means (SMD) between groups and its 95% confidence interval were estimated. RESULTS: Four RCTs (569 participants) were included. The analysis showed a benefit of SNI for certain clinical rhinological symptoms (SMD = -0.29 [-0.45; -0.13]) but no significant improvement of respiratory symptoms (SMD = -0.19 [-0.70; 1.08]) or health status (SMD = -0.30 [-0.68; 0.07]). Its use appeared to limit the prescription of other treatments, whether local or systemic, and particularly antibiotics. Long-term use led to a decrease in the incidence of acute rhinosinusitis and its complications. SNI appeared to be a safe treatment. CONCLUSIONS: SNI is beneficial for rhinological symptoms but not respiratory symptoms. Further research is needed to address the full benefits/risks of this treatment.
PURPOSE: Acute upper respiratory tract infections are the most common infections in infants and children. Saline nasal irrigation (SNI) is widely prescribed and recommended. We conducted a systematic review to assess the efficacy and safety of SNI in infants and children with acute rhinopharyngitis. METHODS: We searched CENTRAL, Medline, Embase and clinicalTrials.gov. Two authors selected randomized control trials (RCTs), including infants ≥3 months and children ≤12 years, comparing the use of isotonic saline solutions, whatever their mode of administration, with one therapeutic abstention, or a therapy deemed less important for nasal lavage. Trial quality was assessed independently by two authors, who, with a third author, extracted and analysed data. Statistical analysis was conducted using Comprehensive Meta-Analysis software. The standard difference in means (SMD) between groups and its 95% confidence interval were estimated. RESULTS: Four RCTs (569 participants) were included. The analysis showed a benefit of SNI for certain clinical rhinological symptoms (SMD = -0.29 [-0.45; -0.13]) but no significant improvement of respiratory symptoms (SMD = -0.19 [-0.70; 1.08]) or health status (SMD = -0.30 [-0.68; 0.07]). Its use appeared to limit the prescription of other treatments, whether local or systemic, and particularly antibiotics. Long-term use led to a decrease in the incidence of acute rhinosinusitis and its complications. SNI appeared to be a safe treatment. CONCLUSIONS: SNI is beneficial for rhinological symptoms but not respiratory symptoms. Further research is needed to address the full benefits/risks of this treatment.