Acute bacterial rhinosinusitis in children: Microbiology and treatment
- Ellen R Wald, MD
Ellen R Wald, MD
- Professor of Pediatrics
- University of Wisconsin School of Medicine and Public Health
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
Acute rhinosinusitis is a disease that results from infection of one or more of the paranasal sinuses. A viral infection associated with the common cold is the most frequent etiology of acute rhinosinusitis, more properly called viral rhinosinusitis. (See "The common cold in children: Clinical features and diagnosis" and "The common cold in children: Management and prevention".)
Uncomplicated viral rhinosinusitis usually resolves without treatment in 7 to 10 days. Although untreated acute bacterial rhinosinusitis (ABRS) also may resolve without treatment, treatment with antibiotics hastens recovery [1,2]. It is important to distinguish between uncomplicated viral rhinosinusitis and ABRS to prevent unnecessary use of antibiotics (table 1).
The microbiology and treatment of ABRS in children will be discussed here. The clinical features and diagnosis of ABRS in children and acute sinusitis and rhinosinusitis in adults are discussed separately. (See "Acute bacterial rhinosinusitis in children: Clinical features and diagnosis" and "Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis" and "Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment".)
The clinical presentation of acute bacterial rhinosinusitis (ABRS) in children is characterized by [3-8]:
●Persistent symptoms (nasal discharge or cough or both) for >10 days without improvement, or
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- CLINICAL PRESENTATIONS
- Common pathogens
- Antimicrobial susceptibility
- Risks for antimicrobial resistance
- INDICATIONS FOR REFERRAL
- EMPIRIC ANTIBIOTIC THERAPY
- General principles
- Outpatient therapy
- - Mild/moderate disease
- - Severe disease or risk for severe disease
- - Penicillin allergy
- - Vomiting
- Inpatient therapy
- Complicated sinusitis
- RESPONSE TO THERAPY
- Treatment failure
- MANAGEMENT OF TREATMENT FAILURE
- In outpatients
- In hospitalized patients
- SYMPTOMATIC TREATMENT
- Topical saline
- Decongestants and antihistamines
- Intranasal corticosteroids
- Sinus aspiration
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS