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Published on: December 31, 2017
Acute bacterial sinusitis in children: an updated review
Alexander Kc Leung1, Kam Lun Hon2,3, Winnie Cw Chu4
1Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada.
Insights
Acute bacterial sinusitis (ABS) affects 7.5% of children with upper respiratory tract infections (URIs). Amoxicillin-clavulanate is the recommended treatment for ABS in children, with dosage adjustments for severity and resistance risk.
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.
Background:
In the pediatric age group, approximately 7.5% of upper respiratory tract infections (URIs) are complicated by acute bacterial sinusitis (ABS). Despite its prevalence, ABS is often overlooked in young children. The diagnosis and management present unique challenges in primary care. This is an updated narrative review on the evaluation, diagnosis, and management of ABS.
Methods:
A PubMed search was performed using the key term 'acute sinusitis'. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English literature and children.
Results:
Haemophilus influenzae (non-typeable), Streptococcus pneumoniae, and Moraxella catarrhalis are the major pathogens in uncomplicated ABS in otherwise healthy children. In complicated ABS, polymicrobial infections are common. The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms.
Conclusion:
Data from high-quality studies on the management of ABS are limited. The present consensus is that amoxicillin-clavulanate, at a standard dose of 45 mg/kg/day orally, is the drug of choice for most cases of uncomplicated ABS in children in whom antibacterial resistance is not suspected. Alternatively, oral amoxicillin 90 mg/kg/day can be administered. For those with severe ABS or uncomplicated acute sinusitis who are at risk for severe disease or antibiotic resistance, oral high-dose amoxicillin-clavulanate (90 mg/kg/day) is the drug of choice.
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