Acute bacterial sinusitis in children: an updated review

Area of Science:

• Pediatric infectious diseases
• Otolaryngology
• Primary care medicine

Background:

• Acute bacterial sinusitis (ABS) complicates approximately 7.5% of pediatric upper respiratory tract infections (URIs).
• ABS is frequently underdiagnosed in young children, posing diagnostic and management challenges in primary care settings.
• This review provides an updated perspective on the evaluation, diagnosis, and management of ABS in pediatric populations.

Purpose of the Study:

• To review the current evidence on the diagnosis and management of acute bacterial sinusitis in children.
• To provide guidance for primary care physicians on identifying and treating ABS in pediatric patients.
• To summarize the recommended antimicrobial therapy for uncomplicated and complicated ABS in children.

Main Methods:

• A comprehensive literature search was conducted on PubMed using the keyword 'acute sinusitis'.
• The search included various study types such as clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews.
• The search was limited to English-language publications focusing on pediatric populations.

Main Results:

• Key pathogens for uncomplicated ABS in children include non-typeable *Haemophilus influenzae*, *Streptococcus pneumoniae*, and *Moraxella catarrhalis*. Complicated ABS often involves polymicrobial infections.
• Diagnosis is primarily clinical, relying on specific criteria such as persistent URI symptoms (>10 days without improvement), high fever with purulent nasal discharge for ≥3 days, or worsening symptoms.
• Limited high-quality data exist for ABS management, but consensus supports amoxicillin-clavulanate as first-line therapy.

Conclusions:

• Amoxicillin-clavulanate (45 mg/kg/day orally) is the preferred treatment for uncomplicated pediatric ABS without suspected resistance.
• High-dose amoxicillin (90 mg/kg/day orally) is an alternative.
• For severe ABS or cases with risk factors for resistance, high-dose amoxicillin-clavulanate (90 mg/kg/day) is recommended.