Acute Bacterial Sinusitis in Children

Practice Gaps

1. Acute bacterial sinusitis should be diagnosed in a child who has an acute upper respiratory tract infection with persistent illness (ie, nasal discharge or daytime cough or both) lasting more than 10 days; worsening cough, worsening or new nasal discharge, or daytime cough or fever after initial improvement; or severe onset of fever and purulent nasal discharge for at least 3 consecutive days.

2. The clinician should prescribe antibiotics for acute bacterial sinusitis in children with severe onset or worsening course. Children with persistent illness should be either prescribed antibiotic therapy or offered additional observation for 3 days.

Objectives

After completing this article, readers should be able to:

1. Understand the mechanisms that lead to bacterial sinusitis.

2. Be able to distinguish the child who has bacterial sinusitis from the one who has only a viral upper respiratory infection or allergic congestion.

3. Be aware of the usefulness of nasal cultures, sinus, aspirate cultures, and findings on imaging in diagnosing bacterial sinusitis.

4. Know the current treatment of bacterial sinusitis, taking into consideration changes in the characteristics of infecting organisms.

The viral upper respiratory tract infection (URI) is the most common illness for which children present to the primary care pediatrician. Approximately 5% to 10% of viral URIs are complicated by acute bacterial sinusitis. Sinusitis results in more than $5.8 billion in health care expenditures in the United States annually, of which $1.8 billion is spent on children younger than 13 years. (1) The diagnosis and treatment of acute bacterial sinusitis present unique challenges to the primary care physician in the acute care setting.

Anatomy and Pathogenesis

The ethmoid and maxillary sinuses develop in the third month of gestation and, although small, …