TABLE 3

Parent Information Regarding Initial Management of Acute Bacterial Sinusitis

How common are sinus infections in children?Thick, colored, or cloudy mucus from your child’s nose frequently occurs with a common cold or viral infection and does not by itself mean your child has sinusitis. In fact, fewer than 1 in 15 children get a true bacterial sinus infection during or after a common cold.
How can I tell if my child has bacterial sinusitis or simply a common cold?Most colds have a runny nose with mucus that typically starts out clear, becomes cloudy or colored, and improves by about 10 d. Some colds will also include fever (temperature >38°C [100.4°F]) for 1 to 2 days. In contrast, acute bacterial sinusitis is likely when the pattern of illness is persistent, severe, or worsening.
 1. Persistent sinusitis is the most common type, defined as runny nose (of any quality), daytime cough (which may be worse at night), or both for at least 10 days without improvement.
 2. Severe sinusitis is present when fever (temperature ≥39°C [102.2°F]) lasts for at least 3 days in a row and is accompanied by nasal mucus that is thick, colored, or cloudy.
 3. Worsening sinusitis starts with a viral cold, which begins to improve but then worsens when bacteria take over and cause new-onset fever (temperature ≥38°C [100.4°F]) or a substantial increase in daytime cough or runny nose.
If my child has sinusitis, should he or she take an antibiotic?Children with persistent sinusitis may be managed with either an antibiotic or with an additional brief period of observation, allowing the child up to another 3 days to fight the infection and improve on his or her own. The choice to treat or observe should be discussed with your doctor and may be based on your child’s quality of life and how much of a problem the sinusitis is causing. In contrast, all children diagnosed with severe or worsening sinusitis should start antibiotic treatment to help them recover faster and more often.
Why not give all children with acute bacterial sinusitis an immediate antibiotic? Some episodes of persistent sinusitis include relatively mild symptoms that may improve on their own in a few days. In addition, antibiotics can have adverse effects, which may include vomiting, diarrhea, upset stomach, skin rash, allergic reactions, yeast infections, and development of resistant bacteria (that make future infections more difficult to treat).