What changes were made when the AAP updated its guidelines for the diagnosis and management of acute bacterial sinusitis (sinus infection) in children and adolescents?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In June 2013, the American Academy of Pediatrics published updated guidelines on the diagnosis and management of acute bacterial sinusitis in children and adolescents. Changes include the following:

  • Previous diagnostic criteria for acute bacterial sinusitis in children were acute upper respiratory tract infection (URI) with either nasal discharge and/or daytime cough for longer than 10 days or severe onset of fever, purulent nasal discharge, and other respiratory symptoms for 3 or more consecutive days. A third criterion added to the updated guideline is URI with worsening symptoms such as nasal discharge, cough, and fever after initial improvement.

  • Physicians may now observe children with persistent infection lasting longer than 10 days for an additional 3 days before prescribing antibiotics, but antibiotics should still be given to children with severe onset or worsening symptoms.

  • First-line therapy is amoxicillin with or without clavulanate.

  • Imaging tests are not recommended for children with uncomplicated acute bacterial sinusitis, although children with suspected orbital or CNS complications should undergo CT scanning of the paranasal sinuses.


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