Upper respiratory infections are some of the most common reasons for pediatric patients to present to the emergency department. A small percentage of these viral infections can evolve into acute bacterial sinusitis (ABS), which can be further complicated by the development of orbital, intracranial, and osseous complications. Differentiating between viral upper respiratory infections and ABS and identifying cases of ABS that require antibiotics can pose a challenge.
Our recent issue Pediatric Sinusitis: Complications and Management in the Emergency Department highlights the patterns of illness that are most consistent with ABS, based on the most current clinical practice guidelines. Additionally, this issue reviews clinical features that should raise suspicion for complicated disease and provides associated diagnostic and management pearls.
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Here are a few key points:
- Children with sinusitis symptoms (nasal discharge of any quality and cough) meeting either the persistent, severe, or biphasic illness pattern (as described in the American Academy of Pediatrics clinical practice guidelines; see Figure 4) can be diagnosed with acute bacterial sinusitis (ABS).4
- Patients with uncomplicated ABS following either a severe or biphasic illness pattern should be treated with oral antibiotics, while those following a persistent pattern can be treated with either oral antibiotics or monitored off antibiotics with close outpatient follow-up within 48 to 72 hours.4
- First-line antibiotic treatment for uncomplicated ABS is high-dose amoxicillin with or without clavulanate.4,5 Alternative antibiotic options are listed in Table 7.
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