Acute Bacterial Sinusitis in Children

• The most common predisposing factors for acute bacterial sinusitis are:
• viral upper respiratory tract infection (URI)
• allergy
• Approximately 80% of episodes of acute bacterial sinusitis are preceded by a viral URI infection
• Children who attend day care are twice as likely to have sinusitis after a URI
• Diagnosis

• Treatment
• High-dose amoxicillin–clavulanate (90 mg/kg/d, divided bid) is first-line therapy for children
• in penicillin-resistant areas w/ resistance rates are of 10% or higher
• in day care
• > 2 years of age
• who have been hospitalized or treated with abx in the past month
• If the above risk factors are not present, standard-dose amoxicillin–clavulanate (40 mg/kg/d divided bid) is recommended
• Macrolides and TMP-SMX (bactrim) not recommended d/t high national rates of resistance
• Levofloxacin is recommended for children with h/o type I hypersensitivity reaction to PCN
• Recommended duration of therapy w/ amoxicillin–clavulanate or levofloxacin is 10-14 days in children

Reference: NEJM