What are the treatment options for pediatric sinus infections?

From the Guidelines

Treatment options for pediatric sinus infections typically begin with supportive care and watchful waiting for 7-10 days, as most cases are viral and resolve on their own. Supportive measures include nasal saline irrigation, adequate hydration, and over-the-counter pain relievers like acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for discomfort. For bacterial sinusitis, which is suspected when symptoms persist beyond 10 days, worsen after initial improvement, or are severe from onset with high fever, antibiotics may be necessary.

• First-line antibiotic therapy is typically amoxicillin (45 mg/kg/day divided twice daily) for 10-14 days, or amoxicillin-clavulanate (45 mg/kg/day of the amoxicillin component) for children with risk factors for resistant bacteria, as recommended by the American Academy of Pediatrics 1.
• For penicillin-allergic patients, alternatives include cefdinir, cefuroxime, or, in cases of non-type I allergies, clindamycin plus a third-generation cephalosporin.
• Nasal corticosteroid sprays like fluticasone (1-2 sprays per nostril daily for children over 4) may help reduce inflammation.
• Decongestants should be used cautiously and only short-term in children over 6. If symptoms persist despite appropriate treatment, or if complications like orbital or intracranial involvement occur, referral to an ENT specialist is warranted for possible imaging or surgical intervention, with CT or MRI of the head and paranasal sinuses with IV contrast recommended for suspected complications 1.

From the FDA Drug Label

Acute Bacterial Sinusitis The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute bacterial sinusitis is 10 mg/kg once daily for 3 days. OTITIS MEDIA AND ACUTE BACTERIAL SINUSITIS: (3-Day Regimen) * Dosing Calculated on 10 mg/kg/day Weight100 mg/5 mL200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs.Day 1–3Day 1–3 5112.5 mL (1/2 tsp) 7.5 mL150 mg 10225 mL (1 tsp) 15 mL300 mg 20445 mL (1 tsp) 15 mL600 mg 30667.5 mL (1 ½ tsp) 22.5 mL900 mg 408810 mL (2 tsp) 30 mL1200 mg 50 and above110 and above12.5 mL (2 ½ tsp) 37. 5 mL1500 mg

The treatment options for pediatric sinus infections include azithromycin oral suspension at a dose of 10 mg/kg once daily for 3 days.

• The dosage is based on the patient's weight, with the following guidelines:

• 5-10 kg: 12.5 mL (1/2 tsp) per day
• 10-20 kg: 25 mL (1 tsp) per day
• 20-30 kg: 45 mL (1 tsp) per day
• 30-40 kg: 67.5 mL (1 ½ tsp) per day
• 40-50 kg: 81-90 mL (2 tsp) per day
• 50 kg and above: 110-120 mL (2 ½ tsp) per day

• The total treatment course is 3 days, with the same dose given each day. 2

From the Research

Treatment Options for Pediatric Sinus Infections

• Antibiotic therapy is a common treatment option for pediatric sinus infections, with high-dose amoxicillin or amoxicillin-clavulanate being the first line of treatment 3
• For patients who are allergic to penicillin or unresponsive to amoxicillin, alternative antibiotics such as cefuroxime, cefpodoxime, or cefdinir may be prescribed 3
• In cases of serious drug allergy, clarithromycin or azithromycin may be used as alternative treatments 3
• Nasal irrigation with saline solution has been shown to be an effective adjunctive treatment for pediatric acute sinusitis, improving symptoms and quality of life 4, 5
• The use of nasal irrigation with saline solution may also reduce symptom severity in children with upper respiratory tract infections 5

Diagnosis and Evaluation

• The diagnosis of acute bacterial sinusitis in children can be based on clinical criteria, with imaging studies such as computed tomography scans reserved for cases with complications or persistent infections 6
• Clinical symptoms, radiography, and sinus aspiration can be used to confirm the diagnosis of acute bacterial sinusitis 6

Antibiotic Efficacy

• Studies have shown that antibiotic therapy can be effective in treating acute bacterial sinusitis in children, with azithromycin being as effective as amoxicillin/clavulanate in some cases 7
• The choice of antibiotic should be based on the suspected causative pathogens and the patient's medical history, including any allergies or previous antibiotic use 3, 6