Content area
Full text
Upper respiratory tract infections are very common in the pediatric population and many of the various pharmacotherapeutic treatment options for these infections have been previously discussed in the Pharmacology Consult column, including antibiotics, over-the-counter products and intranasal corticosteroid agents.
This month's column will review the use of nasal saline-based products, including irrigations, sprays, drops or other dosage forms, that have also been studied and advocated to treat and prevent the symptoms associated with various maladies of the upper respiratory tract in children.
Clinical uses
Saline solution applied nasally has been evaluated in controlled trials for a variety of conditions, including acute and chronic rhinosinusitis, allergic conditions and acute upper respiratory infection (URI).
Although many of these studies have been conducted in adults, several controlled trials have been conducted in children. Evidence from adult trials indicates that nasal saline irrigation effectively reduces symptoms associated with chronic rhinosinusitis, and use of nasal saline solutions may also be helpful for allergic rhinitis and acute URI.
Several adult controlled trials evaluating saline irrigation have been published, with positive results. A recently published Cochrane review concluded that benefits from nasal saline irrigation outweigh minor, common adverse effects when used for chronic rhinosinusitis. Not all adult studies evaluating nasal saline solutions have demonstrated effectiveness, however.
In a controlled trial of adults with URI or acute rhinosinusitis, thrice-daily hypertonic saline spray was compared with normal saline spray or observation. No benefit was noted on symptom resolution for either saline spray product as compared with observation in this trial. In another controlled trial, isotonic saline large volume, low-pressure nasal irrigation was compared with saline nasal spray in adults with chronic nasal and sinus symptoms. Although trial participants randomly assigned to nasal saline spray demonstrated improved symptom scores with treatment, participants treated with saline irrigation improved significantly more.
Pediatric studies
Irrigation with normal saline was evaluated in children aged 3 to 12 years with acute sinusitis in a controlled, randomized study of three weeks duration. All 69 children received antibiotics, mucolytics and nasal decongestants. The treatment group additionally received nasal irrigation with normal saline. A volume of 15 to 20 mL of normal saline was administered into each nostril one to three times daily in a fast, upward sitting or standing position.
Treatment...