Summary of Other Published Guidelines for the Management of Acute Sinusitis in Children

GuidelineAntimicrobial Guidelines for Acute Bacterial Sinusitis (Sinus and Allergy Health Partnership, 2004)39Cincinnati Children’s Hospital Evidence-Based Guideline (2006)40European Position Paper on Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps (2007)41Guidelines for Treatment of Acute and Subacute Rhinosinusitis in Children (Italy, 2008)42
DiagnosisNo resolution after 10 d or worsens after 5–7 d with any of the following: nasal drainage, nasal congestion, facial pressure/pain, postnasal drainage, hyposmia/anosmia, fever, cough, fatigue, maxillary dental pain, and ear pressure/fullnessClinical: at least 10 d without improvement(1) Cold with nasal discharge, daytime cough worsening at night >10 d(1) URTI without improvement within 10 d
Specific note: character of nasal discharge is not useful(2) Cold that seems more severe than usual(2) URTI with severe symptoms (high fever, purulent rhinorrhea, headache, facial pain)
(3) Cold that was improving but suddenly worsens(3) URTI that completely recedes within 3–4 d but recurs within 10 d
ImagingNot recommended routinelyNot routinely recommendedNot recommendedNot recommended
For children with persistent findings or complications, imaging decisions should be made in consultation with consulting subspecialistsCT when surgery being considered
AntimicrobialsMild disease, no recent antibiotics: amoxicillin/clavulanate, amoxicillin, cefpodoxime, cefuroxime, cefdinirFirst-line: high-dose amoxicillin or amoxicillin/clavulanate for 10–14 dRecommended: specific agents not discussedAmoxicillin 50 mg/kg per day
For allergies: TMP/SMX, macrolidesSecond-line: cefuroxime, cefpodoxime, cefdinirIf recent antibiotic exposure, school-attendance, or suspicion of antibiotic-resistant pathogens: Amoxicillin/clavulanate (80-90 mg/kg per day),cefuroxime (30 mg/kg per day), or cefaclor (50 mg/kg per day)
Moderate disease or mild disease with recent antibiotics: amoxicillin/clavulanate (high-dose), ceftriaxoneFor allergies: second-line antibiotics if non-type I reaction
For allergies, same as above, plus clindamycinClarithromycin or azithromycin for type I reaction
Adjuvant therapiesNANot recommended (antitussives, mucolytics, inhaled steroids, β2- agonists, antihistamines, decongestants)Topical steroids (in addition to systemic antibiotics) listed as a level Ib recommendation (from at least 1 RCT)Antihistamines, corticosteroids, decongestants, expectorants, mucolytics, and vasoconstrictors not recommended
Antibiotic prophylaxis not recommended
ComplicationsNAConsult otolaryngologist and/or ophthalmologistImmediate referral/hospitalizationPrompt, aggressive, multidisciplinary intervention
  • This table incorporates pediatric-specific guidelines (Cincinnati, Italy) as well as general guidelines with pediatric-specific recommendations (Sinus and Allergy Health Partnership, European Position Paper). CT, computed tomography; NA; not applicable; RCT, randomized controlled trial; TMP/SMX, trimethoprim/sulfamethoxazole; URTI, upper respiratory tract infection.