Posted: July 22nd, 2024

Pediatric Client with Acute Bacterial Sinusitis

Pediatric Client with Acute Bacterial Sinusitis

Clinical criteria supporting diagnosis in pediatric patients (newborn to 21 years):

Persistent Symptoms:

Nasal discharge (of any quality) or daytime cough, or both, lasting more than 10 days without improvement

Severe Onset of Symptoms:

Concurrent fever (temperature ≥ 39°C/102.2°F)

Purulent nasal discharge for at least 3 consecutive days

Worsening Symptoms:

Worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement

Imaging studies indication: Imaging studies are generally not recommended for uncomplicated cases of acute bacterial sinusitis. They may be considered in cases of suspected complications, such as orbital or central nervous system involvement, or in cases of very severe or persistent symptoms not responding to appropriate antibiotic therapy (Hauk, 2014).

Recommended Antibiotic for Child with No Known Allergies: Amoxicillin

Dose: 90 mg/kg/day in 2 divided doses

Frequency: Every 12 hours

Maximum dose: 3 g/day

Duration: 10-14 days

Example prescription: Amoxicillin 400 mg/5 mL suspension, 10 mL orally twice daily for 14 days

Second-line Recommended Antibiotic for Child with PCN allergy: Cefdinir

Dose: 14 mg/kg/day in 1 or 2 divided doses

Frequency: Once or twice daily

Maximum dose: 600 mg/day

Duration: 10-14 days

Example prescription: Cefdinir 250 mg/5 mL suspension, 5 mL orally twice daily for 14 days

Referral indication: Referral to an otolaryngologist or infectious disease specialist is indicated in cases of:

Complications (e.g., orbital or intracranial involvement)

Very severe or persistent symptoms unresponsive to appropriate antibiotic therapy

Recurrent sinusitis

Immunocompromised patients with sinusitis

Additional medications and treatment strategies:

Intranasal corticosteroids: May help reduce inflammation and improve symptoms

Saline nasal irrigation: Can help clear nasal passages and improve mucus drainage

Analgesics/antipyretics (e.g., acetaminophen, ibuprofen): For pain and fever relief

Decongestants: May provide short-term symptom relief in children over 12 years old

Treatment change for worsening symptoms at 72 hours: If symptoms worsen or fail to improve after 72 hours of initial antibiotic therapy, consider changing to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component, with 6.4 mg/kg/day of clavulanate in 2 divided doses) (Hauk, 2014).

Outpatient 72-hour “observation” acceptability: Outpatient observation without antibiotics is acceptable for children with uncomplicated acute bacterial sinusitis who have mild symptoms (not meeting criteria for severe onset) and are able to follow up closely with their healthcare provider.

Modifications for specific cases:

Four-year-old who is otherwise healthy:

Standard treatment as outlined above

Child with immune deficiency:

More aggressive treatment may be necessary

Consider broader-spectrum antibiotics

Early referral to specialist

Closer monitoring for complications

Child with two prior sinus infections:

Consider high-dose amoxicillin-clavulanate as initial therapy

Longer duration of treatment (14-21 days)

Evaluation for underlying conditions (e.g., allergies, anatomical abnormalities)

Child with cystic fibrosis:

Broader-spectrum antibiotics may be necessary due to potential for resistant organisms

Longer duration of treatment (14-21 days)

Coordination with pulmonology team

More aggressive airway clearance techniques

Other conditions modifying treatment recommendations:

Allergic rhinitis

Anatomical abnormalities (e.g., deviated septum, nasal polyps)

Immunosuppressive conditions (e.g., HIV, chemotherapy)

Recent antibiotic use

Local antibiotic resistance patterns

Presence of complications (e.g., orbital cellulitis, intracranial extension)

References:

Hauk, L. (2014). AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age. American Family Physician, 89(8), 676–681.

Munyemana, M.A., Kallogjeri, D., Chernock, R., Farrell, N.F., Schneider, J.S., Piccirillo, J.F., & Roland, L.T. (2024). Prognostic Factors for Survival Using a Clinical Severity Staging System Among Patients With Acute Invasive Fungal Sinusitis. JAMA Otolaryngology–Head & Neck Surgery, 150(4), 328-334.

Raineau, M., Crowe, A.M., Beccaria, K., Luscan, R., Simon, F., Roux, C.J., Ferroni, A., Kossorotoff, M., Harroche, A., Castelle, M., & Gatbois, E. (2024). Pediatric intracranial empyema complicating otogenic and sinogenic infection. International Journal of Pediatric Otorhinolaryngology, 177, 111860.

Zhou, S., Yu, A., Frank, E., Valencia-Sanchez, B.A., Chen, S., Polster, S.P., & Patel, V.A. (2024). Contemporary Management of Pediatric Invasive Fungal Rhinosinusitis. Current Infectious Disease Reports, 1-11.

Büttner, R., Schwermer, M., Ostermann, T., Längler, A., & Zuzak, T. (2024). Expert consensus-based clinical recommendation for an integrative anthroposophic treatment approach to acute tonsillitis in childhood. Complementary Therapies in Medicine, 81, 103031.

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MN581: Unit 3 Assignment
Applying Current Evidence-Based Practice Guidelines for the Diagnosis and Treatment of Acute Bacterial Sinusitis in Pediatric Patients

This assignment will demonstrate your ability to apply current evidence-based practice guidelines to the management of a pediatric patient diagnosed with acute bacterial sinusitis. Using the Purdue Global Library, you are to locate the following article and use the evidence based recommended guidelines to complete this assignment.

Hauk, L. (2014). AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age. American Family Physician, 89(8), 676–681.

This assignment has a template that you will use to fill in the requested information. Download and complete the Assignment Template.
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MN581: Unit 3 Assignment Template
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.
List Criteria for Severe Onset of Symptoms.
List Criteria for Worsening Symptoms.

When would imaging studies be indicated?
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).
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).
When is Referral indicated?
What additional medications and or treatment strategies are recommended for treatment or symptomatic control
What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic
When is outpatient 72 hour “observation” acceptable?
What modifications would be needed for the following children:
Four year old who is otherwise healthy
Child with immune deficiency
Child with two prior sinus infections
Child with cystic fibrosis
What other conditions would modify these treatment recommendations?

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