Pharmacotherapy of acute sinusitis in children

The pharmacotherapeutic options for acute sinusitis in children are reviewed. Acute sinusitis occurs more frequently in children than in adults. The diagnosis is based primarily on clinical signs and symptoms. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the organisms most frequently implicated. A variety of antimicrobials have FDA-approved labeling for use in the treatment of sinusitis. In randomized, controlled clinical trials identified in a MEDLINE search for the period from 1966 to 1999, amoxicillin had efficacy similar to that of amoxicillin-clavulanate, azithromycin, cefuroxime, and clarithromycin in treating acute sinusitis in children. Azithromycin was effective as a three-day course of treatment. Amoxicillin and cefuroxime are better tolerated than most antibiotics; azithromycin and clarithromycin are also well tolerated. Amoxicillin-clavulanate tends to cause more gastrointestinal symptoms than amoxicillin and is more expensive. Azithromycin is more expensive than amoxicillin but less expensive than other broad-spectrum antimicrobials. Amoxicillin remains the drug of first choice for treating acute sinusitis in children. It has been found to be as effective as other broad-spectrum agents, better tolerated, and less expensive.