| Evidence Based Pediatrics |
| This Page will have ideas based on Randomized Controlled Trials (RCT) studies. This is the best treatment that clinicians should recommend to their patients or parents. If there is no available RCT for managing a problem, a National Guideline will be linked or suggested. Recent valuable studies will be posted only in this page. Before adopting these ideas, you should discuss your situation with your child's clinician. And if they are not recommending or using RCT based treatment ask them why. I think all clinicians should use RCT based management if available. Unfortunately, not all conditions or illnesses have RCT based treatment. Steroids in Strep Throat Hives and Mycoplasma Miralax and Constipation Once a day treatment of Strep throat Wart treatment Conjunctivitis Rizatriptan and Migraine Autism & DHA Chronic Sinusitis (below) Molluscum and KOH In the May-June issue of Pediatric Dermatology Vol. 23, No 3, 279-281, 2006 an article "Double-Blind, Randomized, Placebo-controlled Trial of the Use of Topical 10% Potassium Hydroxide Solution in the Treatment of Molluscum Contagiosum" concluded that Potassium Hydroxide (KOH) is an effective treatment. Seventy per cent of children with molluscum "rashes" treated with KOH got better. Two children in the treatment group developed hyperpigmentation. Two children withdraw from the study because of severe stinging at the site of application. I have used this treatment for more than one year now. And most parents told me that the molluscum "rashes" of their child cleared. A few of my patient's molluscum were gone in two weeks. The following is another abstract that supports this recommendation. Most pediatricians are not aware of this treatment because they do not subscribe to PEDIATRIC DERMATOLOGY.
Pediatr Dermatol.
1999 May-Jun;16(3):228-31.
Treatment of molluscum contagiosum with potassium hydroxide: a clinical approach in 35 children.Department of Dermatology, University of Sao Paulo, Sao Paulo, Brazil. Potassium hydroxide (KOH) is a strong alkali that has long been known to digest proteins, lipids, and most other epithelial debris of skin scrapings to identify fungal infections. To our knowledge, KOH has never been used for the treatment of molluscum contagiosum (MC). We evaluated 35 children with MC for the clinical effectiveness of treatment with topical 10% KOH aqueous solution. The solution was applied by the parents of affected children, twice daily, on each MC lesion. The therapy was continued until all lesions underwent inflammation and superficial ulceration. Thirty-two of 35 patients achieved complete clinical cure after a mean treatment period of 30 days. Three children discontinued treatment: two reported severe stinging of the lesions and refused further applications; the other, with giant MC lesions, developed a secondary infection with prolonged treatment. Therapy with KOH was found to be effective and safe in the treatment of MC in children. Posted 26 Aug 2006 Want to receive new Evidenced Based studies and other recent medical information? Please fill up the form and click Get More Info! Thanks.
This study was done in adults. However, since many parents have chronic sinusitis and this is a RCT idea, I decided to post it. Again, discuss with your clinician before using this research. I will try this management to some of my patients with difficult to control chronic sinusitis especially those with asthma. Maybe this treatment works because some patients with chronic sinusitis has untreated mycoplasma infection plus the anti-inflammatory effect of macrolides.
Laryngoscope.
2006 Feb;116(2):189-93
A double-blind, randomized, placebo-controlled trial of macrolide in the treatment of chronic rhinosinusitis.School of Biomolecular and Biomedical Science, Griffith University, and Princess Alexandria Hospital, Brisbane, Australia. benwallwork@hotmail.com OBJECTIVES: The antiinflammatory effect of macrolide antibiotics has been well-established, as has their role in the treatment of certain disorders of chronic airway inflammation. Several studies have suggested that long-term, low-dose macrolides may be efficacious in the treatment of chronic rhinosinusitis; however, these studies have lacked a control group. To date, this effect has not been tested in a randomized, placebo-controlled study. METHOD: The authors conducted a double-blind, randomized, placebo-controlled clinical trial on 64 patients with chronic rhinosinusitis. Subjects received either 150 mg roxithromycin daily for 3 months or placebo. Outcome measures included the Sinonasal Outcome Test-20 (SNOT-20), measurements of peak nasal inspiratory flow, saccharine transit time, olfactory function, nasal endoscopic scoring, and nasal lavage assays for interleukin-8, fucose, and a2-macroglobulin. RESULTS: There were statistically significant improvements in SNOT-20 score, nasal endoscopy, saccharine transit time, and IL-8 levels in lavage fluid (P<.05) in the macrolide group. A correlation was noted between improved outcome measures and low IgE levels. No significant improvements were noted for olfactory function, peak nasal inspiratory flow, or lavage levels for fucose and a2-macroglobulin. No improvement in any outcome was noted in the placebo-treated patients. CONCLUSION: These findings suggest that macrolides may have a beneficial role in the treatment of chronic rhinosinusitis, particularly in patients with low levels of IgE, and supports the in vitro evidence of their antiinflammatory activity. Additional studies are required to assess their place in clinical practice. Posted: 30 Aug 2006
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