Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Abstract

OBJECTIVE: To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS: Analysis of the medical literature published since the last version of the guideline (2001). RESULTS: The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever [temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening (progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management. If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS: Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

“…The AAP 23 and the Infectious Diseases Society of America 21 recently developed evidence-based clinical guidelines for the diagnosis and treatment of acute bacterial sinusitis. These guidelines support use of strict diagnostic criteria to distinguish bacterial from viral URIs.…”

“…22 Observation therapy may be considered as an alternative strategy to immediate therapy for AOM and sinusitis for older patients without severe symptoms. 22,23 The use of this approach is an opportunity to engage in shared decision-making with patients and families to include a discussion about the potential benefits and risks associated with immediate antibiotic therapy.…”

“…In recent years, several high-quality randomized controlled trials, meta-analyses, and new and updated clinical guidelines have been published that better define the effectiveness of antibiotic use for selected URIs, including AOM and acute bacterial sinusitis. [14][15][16][17][18][19][20][21][22][23] At the same time, new evidence highlighting the extent to which antibiotics lead to adverse events requiring medical attention [4][5][6] or potentially life-threatening events 24,25 has emerged.…”

77 Pediatric Rhinosinusitis

“…[40,3] Adenoidal tissue acts as a bacterial reservoir in children with CRS regardless of their size and removing them improves outcomes [41,24]. Adenoidectomy is highly effective as an initial surgical therapy in children aged up to 6 years, it has been found that the efficiency of this treatment decreases between the age of 6 and 12.…”

Особливості Перебігу Гострих Інфекційних Захворювань Верхніх Дихальних Шляхів У Дитячому Віці (Огляд Літератури)

“…Назофарингеальні бактеріологічні дослідження необ-хідні, якщо є підозра на групу A Streptococcus, Bordetella pertussis або назальну дифтерію. Виділення інших бак-терій здебільшого не свідчить про бактерійну назальну інфекцію, виділені збудники не обов'язково є етіоло-гічним чинником синуситу [14]. Серед ймовірних ускладнень ГРЗ зневоднення відмі-чається переважно в дітей.…”