Acute bacterial sinusitis in children: an updated review

Abstract

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.

Approach to paediatric nasal obstruction

“…10 Acute bacterial rhinosinusitis (ABRS) complicates approximately 7.5% of upper respiratory tract infections in children and is characterised by a prolonged course of illness, more severe illness or a clinical deterioration following initially mild or improving symptoms, referred to as 'double sickening'. 10,18 Differentiating this double sickening of ABRS from the natural course of post-viral rhinosinusitis can be difficult, although more severe disease favours ABRS. 19 The mainstay of acute rhinosinusitis management is supportive therapy.…”

Antibiotic stewardship programmes had a low impact on prescribing for acute respiratory tract infections in children

“…That is why most guidelines suggest that clinicians carry out a streptococcal antigen test and throat culture before making decisions about antibiotic treatment 6 . Acute sinusitis needs to be considered if upper respiratory tract symptoms present with continuing nasal mucous or purulent discharge and a biphasic course with relapsing fever 7 …”

“…6 Acute sinusitis needs to be considered if upper respiratory tract symptoms present with continuing nasal mucous or purulent discharge and a biphasic course with relapsing fever. 7 No new antibiotics have been launched to treat ARTIs in children in the last 20 years 8 and we are seeing increasing antibiotic resistance to bacterial pathogens. 1 This means that exposure to antibiotics must be reduced at the population level to enhance the stewardship of currently available antimicrobial drugs.…”

An Overview on Sinusitis Diagnostic and Management approach in Primary Health Care Centre

“…Therefore, the term rhinosinusitis is more accurate. This condition has multiple triggers and heavily influenced by the seasonal changes, with spike in spring and winter (Leung et al, 2020;Wu et al, 2020). Sinusitis is a very common disease that is encountered, almost daily, in family medicine practice, it is the second most common infection to be seen in this field (Worrall, 2011).…”