Recommendations for Initial Use of Antibiotics for Acute Bacterial Sinusitis

Clinical PresentationSevere Acute Bacterial SinusitisaWorsening Acute Bacterial SinusitisbPersistent Acute Bacterial Sinusitisc
Uncomplicated acute bacterial sinusitis without coexisting illnessAntibiotic therapyAntibiotic therapyAntibiotic therapy or additional observation for 3 daysd
Acute bacterial sinusitis with orbital or intracranial complicationsAntibiotic therapyAntibiotic therapyAntibiotic therapy
Acute bacterial sinusitis with coexisting acute otitis media, pneumonia, adenitis, or streptococcal pharyngitisAntibiotic therapyAntibiotic therapyAntibiotic therapy
  • a Defined as temperature ≥39°C and purulent (thick, colored, and opaque) nasal discharge present concurrently for at least 3 consecutive days.

  • b Defined as nasal discharge or daytime cough with sudden worsening of symptoms (manifested by new-onset fever ≥38°C/100.4°F or substantial increase in nasal discharge or cough) after having experienced transient improvement of symptoms.

  • c Defined as nasal discharge (of any quality), daytime cough (which may be worse at night), or both, persisting for >10 days without improvement.

  • d Opportunity for shared decision-making with the child’s family; if observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens at any time or fails to improve within 3 days of observation.