Clinical Practice Guideline: Management of Sinusitis

,

doi:10.1542/peds.108.3.798

Cited by 370 publications

(31 citation statements)

References 72 publications

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“…The American Academy of Pediatrics practice guidelines for the management of acute bacterial sinusitis and acute otitis media have recommended the use of second- or third-generation cephalosporins in patients with a history of penicillin allergy who did not experience urticaria or anaphylaxis to penicillin [15]. However, the Joint Task Force on Practice Parameters [2] recommends that if a substitute with a non-β-lactam antimicrobial agent is not available for patients needing cephalosporin, patients with a history of an immediate-type hypersensitivity reaction to penicillin should undergo penicillin skin tests.…”

Section: Discussionmentioning

confidence: 99%

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Park

Koch

Klemawesch

et al. 2010

Int Arch Allergy Immunol

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Background: Cephalosporin administration in patients with a history of penicillin allergy is controversial. Studies looking at the safety of cephalosporin in patients with a history of penicillin allergy lacked a control group, had a small number of patients, and/or lacked confirmation of penicillin allergy by penicillin skin testing. The purpose of this study was to determine whether patients with penicillin allergy were at increased risk of adverse drug reactions when administered cephalosporin. Methods: A cohort study of patients with a history of penicillin allergy and a positive or negative penicillin skin test when administered cephalosporin was conducted. Charts were reviewed for adverse drug reactions to cephalosporin after penicillin skin testing. Results: Eighty-five patients with a history of penicillin allergy and positive penicillin skin test and 726 patients with a history of penicillin allergy and negative penicillin skin test were administered cephalosporin. Five (6%) of 85 cases had an adverse drug reaction to cephalosporin as compared to 5 (0.7%) of 726 of the referent population (p = 0.0019). The rate of presumed IgE-mediated adverse drug reactions to the cephalosporins amongst the cases was 2 (2%) of 85 compared to 1 (0.1%) of 726 amongst the referent population (p = 0.0304). Conclusion: A greater risk of an adverse drug reaction to cephalosporin exists in patients with penicillin allergy. We recommend penicillin skin testing if cephalosporin, especially a first-generation cephalosporin, is to be administered to patients with a history of penicillin allergy.

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Section: Discussionmentioning

confidence: 99%

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Park

Koch

Klemawesch

et al. 2010

Int Arch Allergy Immunol

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“…The commonest bacterial pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis . If the bacterial ARS does not dissipate, members of the anaerobic oropharyngeal flora and Staphylococcus aureus emerge as a pathogens 2, 8, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25…”

Section: Microbiologymentioning

confidence: 99%

“…It is estimated that 5% to 13% of viral upper respiratory tract infections in children may progress to acute rhinosinusitis,2, 3 and a proportion of these progressing to a Pediatric CRS (PCRS). PCRS can also occur and/or be aggravated by allergic rhinitis and adenoid disease 4, 5…”

Section: Introductionmentioning

confidence: 99%

The role of antibiotics in pediatric chronic rhinosinusitis

Brook

2017

Laryngoscope Investig Oto

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ObjectivesPresenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology.Data sourceReview of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis.ResultsChronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta‐lactamase producing aerobic and anaerobic organisms, amoxicillin‐clavulanate is the first‐line regimen for most patients. Clindamycin is adequate for penicillin‐allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy.ConclusionsAntimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens.Level of Evidence7.

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“…Therefore mucosal thickening on imaging is not sufficient in diagnosing acute bacterial sinusitis [10]. According to the guidelines given by the American Academy of Pediatrics on management of sinusitis, CT scans of the sinuses should be reserved for children in whom surgery is being considered as a management strategy, including aspiration of the paranasal sinuses [5]. The ACR has recommended that the diagnosis of acute uncomplicated sinusitis should be made on clinical grounds alone and CT imaging should be reserved for patients who do not recover or who worsen during the course of appropriate antimicrobial therapy [10].…”

Section: Discussionmentioning

confidence: 99%

Relationship between clinical sinusitis symptoms and sinus CT severity in pediatric post bone marrow transplant and immunocompetent patients

et al. 2011

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Since typical inflammatory responses may be diminished in children following bone marrow transplant (BMT), computed tomography (CT) imaging of the sinuses has been increasingly ordered to diagnose sinusitis in this group. The objective of this study was to determine the association between clinical sinusitis symptoms and sinus opacification on CT scans in post BMT versus immunocompetent children. Our sample was comprised of 64 post BMT and 86 immunocompetent children with sinus CT scans. CT sinus opacification was scored using the modified Lund–Mackay staging system. The relationship between clinical sinusitis symptoms (rhinorrhea, nasal congestion, cough, headache, and facial pain) and opacification was compared for the two groups. The severity of sinus opacification in the BMT group was significantly higher compared to the immunocompetent group. In combined patient groups the odds ratio (OR) for moderate/severe sinusitis was significantly elevated for rhinorrhea (OR=3.00; 95% confidence interval [CI], 1.27–7.12), cough (OR=2.80; 95% CI, 1.22–6.42), and having either rhinorrhea, nasal congestion, or cough (OR= 4.76; 95% CI, 1.71–13.24). While the immunocompetent group had a greater number of sinusitis symptoms compared to the post BMT group, both groups had a significant increase in the severity on CT with increasing number of symptoms. Conclusion In post BMT patients, our data demonstrated higher odds of moderate/severe sinusitis on CT scans associated with rhinorrhea, cough or nasal congestion. These finding suggest that in post BMT children, detailed sinus history may still play a vital role in the diagnosis of sinusitis.

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Clinical Practice Guideline: Management of Sinusitis

Cited by 370 publications

References 72 publications

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

The role of antibiotics in pediatric chronic rhinosinusitis

Relationship between clinical sinusitis symptoms and sinus CT severity in pediatric post bone marrow transplant and immunocompetent patients

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