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Treatment options for acute sinusitis in children
Despina G Contopoulos-Ioannidis1, John P A Ioannidis
1Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Ioannina 45110, Greece.
Current Allergy and Asthma Reports
|October 7, 2004
Summary
Most childhood acute sinusitis cases resolve spontaneously, even bacterial ones. Antibiotics are reserved for a minority of non-self-resolving infections, with amoxicillin effective for most. High-dose amoxicillin or alternatives are for resistant organisms.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
Background:
- Controversy surrounds optimal diagnosis and treatment of acute sinusitis in children.
- Clinical signs and symptoms can be unreliable, complicating management decisions.
- Most acute sinusitis cases, including bacterial infections, are expected to resolve spontaneously.
Purpose of the Study:
- To identify children with bacterial sinusitis unlikely to resolve spontaneously, who may benefit from antibiotic therapy.
- To review current evidence on antibiotic efficacy, choice, duration, and ancillary measures for pediatric acute sinusitis.
Main Methods:
- Review of existing literature and clinical guidelines on acute sinusitis management.
- Analysis of antibiotic efficacy based on bacterial resistance patterns.
- Evaluation of evidence for ancillary treatments like nasal corticosteroids.
Main Results:
- Antibiotics are indicated for a minority of acute sinusitis cases that do not resolve spontaneously.
- Standard-dose amoxicillin is effective for approximately 80% of bacterial infections.
- High-dose amoxicillin or amoxicillin/clavulanate are recommended for children at high risk for resistant organisms.
Conclusions:
- Antibiotic stewardship is crucial in pediatric acute sinusitis, reserving treatment for specific indications.
- Amoxicillin remains a primary choice, with alternatives for resistant strains.
- Evidence supporting ancillary measures is currently limited.