Skip to main content

Advertisement

SpringerLink
Log in

Treatment options for acute sinusitis in children

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Much controversy exists regarding the best diagnostic method for acute sinusitis, the efficacy of antibiotics, the best choice of antibiotics, the most appropriate duration of therapy, and the efficacy of ancillary measures and nasal corticosteroids. The therapeutic goal is to identify those children who are more likely to have bacterial sinusitis and unlikely to resolve spontaneously, who may require treatment with antibiotics. The inaccuracy of clinical signs and symptoms complicates further the management of these children. Acute sinusitis is expected to resolve spontaneously in most cases, including many cases of bacterial sinusitis. Antibiotics are needed only for a minority of non-self-resolving infections. Based on current resistance considerations, approximately 80% of bacterial infections are expected to respond to standard doses of amoxicillin. High-dose amoxicillin, amoxicillin/clavulanate, or other β-lactam antibiotics should be considered for children at high risk for carrying resistant organisms. Evidence for the effectiveness of ancillary measures is limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. McCaig LF, Besser RE, Hughes JM: Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002, 287:3096–3102. An interesting article showing trends for antibiotic prescription. Sinusitis prescriptions have not decreased, unlike those of other upper respiratory tract indications.

    Article  PubMed  Google Scholar 

  2. Bauchner H, Pelton SI, Klein JO: Parents, physicians, and antibiotic use. Pediatrics 1999, 103:395–401.

    Article  PubMed  CAS  Google Scholar 

  3. Dosh SA, Hickner JM, Mainous AG 3rd, Ebell MH: Predictors of antibiotic prescribing for nonspecific upper respiratory infections, acute bronchitis, and acute sinusitis. An UPRNet study. Upper Peninsula Research Network. J Fam Pract 2000, 49:407–414.

    PubMed  CAS  Google Scholar 

  4. De Sutter AI, De Meyere MJ, De Maeseneer JM, Peersman WP: Antibiotic prescribing in acute infections of the nose or sinuses: a matter of personal habit? Fam Pract 2001, 18:209–213.

    Article  PubMed  Google Scholar 

  5. Contopoulos-Ioannidis DG, Koliofoti ID, Koutroumpa IC, et al.: Pathways for inappropriate dispensing of antibiotics for rhinosinusitis: a randomized trial. Clin Infect Dis 2001, 33:76–82.

    Article  PubMed  CAS  Google Scholar 

  6. Anon JB, Jacobs MR, Poole MD, et al.: Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2004, 130(1 Suppl):1–45.

    PubMed  Google Scholar 

  7. Sinus and Allergy Health Partnership: Antimicrobial treatment guidelines for acute bacterial rhinosinusitis: executive summary. Otolaryngol Head Neck Surg 2000, 123:1–4.

    Article  Google Scholar 

  8. Contopoulos-Ioannidis DG, Ioannidis JP, Lau J: Acute sinusitis in children: current treatment strategies. Paediatr Drugs 2003, 5:71–80.

    PubMed  Google Scholar 

  9. Garbutt JM, Gellman EF, Littenberg B: The development and validation of an instrument to assess acute sinus disease in children. Qual Life Res 1999, 8:225–233.

    Article  PubMed  CAS  Google Scholar 

  10. Wald ER, Chiponis D, Ledesma-Medina J: Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics 1986, 77:795–800. The classic randomized trial showing effectiveness of antibiotics for children meeting specific criteria.

    PubMed  CAS  Google Scholar 

  11. Engels EA, Terrin N, Barza M, Lau J: Meta-analysis of diagnostic tests for acute sinusitis. J Clin Epidemiol 2000, 53:852–862.

    Article  PubMed  CAS  Google Scholar 

  12. Varonen H, Makela M, Savolainen S, et al.: Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol 2000, 53:940–948.

    Article  PubMed  CAS  Google Scholar 

  13. Berg O, Carenfelt C: Analysis of symptoms and clinical signs in the maxillary sinus empyema. Acta Otolaryngol 1988, 105:343–349.

    PubMed  CAS  Google Scholar 

  14. Berg O, Carenfelt C: Etiological diagnosis in sinusitis: ultrasonography as clinical complement. Laryngoscope 1985, 95:851–853.

    PubMed  CAS  Google Scholar 

  15. Bucher HC, Tschudi P, Young J, et al.: Effect of amoxicillinclavulanate in clinically diagnosed acute rhinosinusitis: a placebo-controlled, double-blind, randomized trial in general practice. Arch Intern Med 2003, 163:1793–1798.

    Article  PubMed  CAS  Google Scholar 

  16. Young J, Bucher H, Tschudi P, et al.: The clinical diagnosis of acute bacterial rhinosinusitis in general practice and its therapeutic consequences. J Clin Epidemiol 2003, 56:377–384.

    Article  PubMed  Google Scholar 

  17. Lacroix JS, Ricchetti A, Lew D, et al.: Symptoms and clinical and radiological signs predicting the presence of pathogenic bacteria in acute rhinosinusitis. Acta Otolaryngol 2002, 122:192–196.

    Article  PubMed  Google Scholar 

  18. McAlister WH, Parker BR, Kushner DC, et al.: Sinusitis in the pediatric population. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000, 215(Suppl):811–818.

    PubMed  Google Scholar 

  19. Balk EM, Zucker DR, Engels EA, et al.: Strategies for diagnosing and treating suspected acute bacterial sinusitis: a costeffectiveness analysis. J Gen Intern Med 2001, 16:701–711.

    Article  PubMed  CAS  Google Scholar 

  20. Ioannidis JP, Lau J: Technical report: evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: a systematic overview. Pediatrics 2001, 108:E57. A systematic review of the available evidence for acute sinusitis in children.

    Article  PubMed  CAS  Google Scholar 

  21. Jannert M, Andreasson L, Helin I, Pettersson H: Acute sinusitis in children: symptoms, clinical findings and bacteriology related to initial radiologic appearance. Int J Pediatr Otorhinolaryngol 1982, 4:139–148.

    Article  PubMed  CAS  Google Scholar 

  22. Clinical practice guideline: management of sinusitis. Pediatrics 2001, 108:798–808. Official guidelines from the American Academy of Pediatrics.

  23. Manning SC, Biavati MJ, Phillips DL: Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996, 37:65–74.

    Article  PubMed  CAS  Google Scholar 

  24. Glasier CM, Ascher DP, Williams KD: Incidental paranasal sinus abnormalities on CT of children: clinical correlation. AJNR Am J Neuroradiol 1986, 7:861–864.

    PubMed  CAS  Google Scholar 

  25. McAlister WH, Kronemer K: Imaging of sinusitis in children. Pediatr Infect Dis J 1999, 18:1019–1020.

    Article  PubMed  CAS  Google Scholar 

  26. Lim WK, Ram B, Fasulakis S, Kane KJ: Incidental magnetic resonance image sinus abnormalities in asymptomatic Australian children. J Laryngol Otol 2003, 117:969–972.

    Article  PubMed  Google Scholar 

  27. Kristo A, Uhari M, Luotonen J, et al.: Paranasal sinus findings in children during respiratory infection evaluated with magnetic resonance imaging. Pediatrics 2003, 111:e586-e589.

    Article  PubMed  Google Scholar 

  28. Van Buchem FL, Peeters MF, Knottnerus JA: Maxillary sinusitis in children. Clin Otolaryngol 1992, 17:49–53.

    PubMed  Google Scholar 

  29. Benninger MS, Appelbaum PC, Denneny JC, et al.: Maxillary sinus puncture and culture in the diagnosis of acute rhinosinusitis: the case for pursuing alternative culture methods. Otolaryngol Head Neck Surg 2002, 127:7–12.

    Article  PubMed  Google Scholar 

  30. Kaiser L, Morabia A, Stalder H, et al.: Role of nasopharyngeal culture in antibiotic prescription for patients with common cold or acute sinusitis. Eur J Clin Microbiol Infect Dis 2001, 20:445–451.

    Article  PubMed  CAS  Google Scholar 

  31. Garbutt JM, Goldstein M, Gellman E, et al.: A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics 2001, 107:619–25. A randomized trial showing no benefit from the use of antibiotics at regular doses.

    Article  PubMed  CAS  Google Scholar 

  32. De Sutter AI, De Meyere MJ, Christiaens TC, et al.: Does amoxicillin improve outcomes in patients with purulent rhinorrhea? A pragmatic randomized double-blind controlled trial in family practice. J Fam Pract 2002, 51:317–323.

    PubMed  Google Scholar 

  33. Jacobs MR, Felmingham D, Appelbaum PC, Gruneberg RN: The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 2003, 52:229–246.

    Article  PubMed  CAS  Google Scholar 

  34. Jacobs MR, Bajaksouzian S, Zilles A, et al.: Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. Surveillance study. Antimicrob Agents Chemother 1999, 43:1901–1908.

    PubMed  CAS  Google Scholar 

  35. Peric M, Bozdogan B, Jacobs MR, Appelbaum PC: Effects of an efflux mechanism and ribosomal mutations on macrolide susceptibility of Haemophilus influenzae clinical isolates. Antimicrob Agents Chemother 2003, 47:1017–1022.

    Article  PubMed  CAS  Google Scholar 

  36. Poole MD: A mathematical therapeutic outcomes model for sinusitis. Otolaryngol Head Neck Surg 2004, 130(1Suppl):46–50.

    Article  PubMed  Google Scholar 

  37. Powers JL, Gooch WM, Oddo LP: Comparison of the palatability of the oral suspension of cefdinir vs. amoxicillin/clavulanate potassium, cefprozil and azithromycin in pediatric patients. Pediatr Infect Dis J 2000, 19(12Suppl):S174-S180.

    PubMed  CAS  Google Scholar 

  38. Guay D: Short-course antimicrobial therapy of respiratory tract infections. Drugs 2003, 63:2169–2184.

    Article  PubMed  CAS  Google Scholar 

  39. Ficnar B, Huzjak N, Oreskovic K, et al.: Azithromycin: 3-day versus 5-day course in the treatment of respiratory tract infections in children. Croatian Azithromycin Study Group. J Chemother 1997, 9:38–43.

    PubMed  CAS  Google Scholar 

  40. Ng DK, Chow PY, Leung L, et al.: A randomized controlled trial of azithromycin and amoxicillin/clavulanate in the management of subacute childhood rhinosinusitis. J Paediatr Child Health 2000, 36:378–381.

    Article  PubMed  CAS  Google Scholar 

  41. Schrag SJ, Pena C, Fernandez J, et al.: Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomized trial. JAMA 2001, 286:49–56.

    Article  PubMed  CAS  Google Scholar 

  42. Barlan IB, Erkan E, Bakir M, et al.: Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Ann Allergy Asthma Immunol 1997, 78:598–601.

    PubMed  CAS  Google Scholar 

  43. McCormick DP, John SD, Swischuk LE, Uchida T: A doubleblind, placebo-controlled trial of decongestant-antihistamine for the treatment of sinusitis in children. Clin Pediatr (Phila) 1996, 35:457–460.

    Article  CAS  Google Scholar 

  44. Yilmaz G, Varan B, Yilmaz T, Gurakan B: Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Eur Arch Otorhinolaryngol 2000, 257:256–259.

    Article  PubMed  CAS  Google Scholar 

  45. Karadag A: Nasal saline for acute sinusitis. Pediatrics 2002, 109:165.

    Article  PubMed  Google Scholar 

  46. Nayak AS, Settipane GA, Pedinoff A, et al.: Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis. Ann Allergy Asthma Immunol 2002, 89:271–278.

    Article  PubMed  CAS  Google Scholar 

  47. Meltzer EO, Charous BL, Busse WW, et al.: Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. The Nasonex Sinusitis Group. J Allergy Clin Immunol 2000, 106:630–637.

    Article  PubMed  CAS  Google Scholar 

  48. Dolor RJ, Witsell DL, Hellkamp AS, et al.: Comparison of cefuroxime with or without intranasal fluticasone for the treatment of rhinosinusitis. The CAFFS Trial: a randomized controlled trial. JAMA 2001, 286:3097–3105.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece

    Despina G. Contopoulos-Ioannidis MD & John P. A. Ioannidis MD

Authors
  1. Despina G. Contopoulos-Ioannidis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. A. Ioannidis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Contopoulos-Ioannidis, D.G., Ioannidis, J.P.A. Treatment options for acute sinusitis in children. Curr Allergy Asthma Rep 4, 471–477 (2004). https://doi.org/10.1007/s11882-004-0014-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-004-0014-4

Keywords

Search

Navigation