What are the AAP guidelines for the diagnosis and management of acute sinusitis in children?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In 2013, the American Academy of Pediatrics (AAP) released clinical practice guidelines for the diagnosis and management of acute bacterial sinusitis in children. According to the guidelines, a diagnosis of acute bacterial sinusitis should be made when a child with an acute upper respiratory tract infection (URI) presents with persistent illness (ie, nasal discharge and/or daytime cough) lasting more than 10 days without improvement; a worsening course or new onset of nasal discharge, daytime cough, or fever after initial improvement; or severe onset (ie, fever and purulent nasal discharge) for at least 3 consecutive days. [18]

Other key action statements include the following [18] :

  • Imaging studies (plain films, contrast-enhanced CT scans, magnetic resonance imaging [MRI] scans, or ultrasonograms) are not recommended to distinguish acute bacterial sinusitis from viral URI 
  • A contrast-enhanced CT scan of the paranasal sinuses and/or an MRI scan with contrast should be performed if orbital or central nervous system complications are suspected
  • Prescribe antibiotic therapy for acute bacterial sinusitis in children with a severe onset or worsening course (signs, symptoms, or both)
  • Prescribe antibiotic therapy or offer additional outpatient observation for 3 days to children with persistent illness (nasal discharge of any quality and/or cough for at least 10 days without evidence of improvement) 
  • Prescribe amoxicillin, with or without clavulanate, as first-line treatment when a decision has been made to initiate antibiotic therapy 
  • Reassess initial management if there is either a caregiver report of worsening or failure to improve within 72 hours of initial management
  • If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve in 72 hours, then antibiotic therapy may be changed for patients initially managed with antibiotic or antibiotic treatment may be started for patients initially managed with observation

The 2014 AAAAI/ACAAI practice parameter recommends that clinician's look for the presence of otitis media when evaluating a patient with rhinosinusitis. The AAAAI/ACAAI also notes there is no evidence to support the use of nasal irrigations, antihistamines, decongestants, or mucolytics as ancillary therapy in the treatment of ABRS in children. [13]

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