Pediatric Client with Acute Bacterial Sinusitis

Pediatric Client with Acute Bacterial Sinusitis

List the clinical criteria that must be present to support this diagnosis in pediatric patients from newborn to 21 years of age. Categorize clinical signs and symptoms by: Persistent Symptoms, Severe Onset, or Worsening Symptoms.


List Criteria for Persistent Symptoms.


·         0–30 days without improvement

·         Nasal discharge

·         Daytime cough that worsens worse at night

·         Variable fever

·         Variable headache and facial pain


List Criteria for Severe Onset of Symptoms.


·         Purulent rhinorrhea

·         High fever that is above 39o C)

·         Purulent nasal discharge simultaneously for minimum of 3 to 4 days


List Criteria for Worsening Symptoms


·         Cough or nasal discharge for five to six days

·         Increased nasal discharge

·         Increased coughing

·         Onset of new fever

·         Onset of severe headache








(Badr et al, 2016)

 When would imaging studies be indicated?


Imaging for pediatric patients with cute sinusitis should be performed when the patient is suspected to having orbital complication or central nervous system complications  (Pynnonen et al, 2015).
What is the recommended Antibiotic for Child with No Known Allergies?

Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information).


Amoxicillin at 45 mg/kg/day in 2 doses

Duration of treatment: 10 days




(Badr et al, 2016)



What is the second line Recommended Antibiotic for Child with allergy to PCN

Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information).


50 mg/kg Ceftriaxone IV or IM

Duration of treatment: 10, 14, 21, 28 days Pediatric Client with Acute Bacterial Sinusitis



(American Academy of Family Physicians, 2014).

When is Referral indicated?


If the child is having systemic toxic effects, sinusitis complications, or is unable to take oral antibiotics

(Pynnonen et al, 2015).

What additional medications and or treatment strategies are recommended for treatment or symptomatic control


·         Acetaminophen for pain, fever or discomfort control

·         Intranasal corticosteroids

·         Gentle nasal irrigation

What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic


Amoxicillin-clavulanate (Pynnonen et al, 2015).
When is outpatient 72 hour “observation” acceptable?


If there is no symptom worsening
What modifications would be needed for the following children:

Four-year-old who is otherwise healthy


Not indicated
Child with immune deficiency


Amoxicillin-clavulanate, 90mg/kg/day for 14 days

(American Academy of Family Physicians, 2014). Pediatric Client with Acute Bacterial Sinusitis

Child with two prior sinus infections


Surgical intervention might be indicated

(Pynnonen et al, 2015).

Child with cystic fibrosis


Endoscopic sinus surgery is recommended


What other conditions would modify these treatment recommendations?


Allergic rhinitis, gastroesophageal reflux, and anatomical abnormalities (Badr et al, 2016)


American Academy of Family Physicians. (2014). AAP Releases Guideline on Diagnosis and Management of Acute Bacterial Sinusitis in Children One to 18 Years of Age. Am Fam Physician. 89(8),676-681.

Badr D, Gaffin J & Wanda P. (2016). Pediatric Rhinosinusitis. Curr Treat Options Allergy. 3(3), 268–281.

Pynnonen M, Lynn S, Kern H, Novis S, Akkina S, Nahid K & Davis M. (2015). Diagnosis and treatment of acute sinusitis in the primary care setting: a retrospective cohort. Laryngoscope. 125(10), 2266–2272.

MN580assignmentjg (1)

Pediatric Client with Acute Bacterial Sinusitis


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