What is the most effective antibiotic treatment for pediatric patients with acute sinusitis (inflammation of the paranasal sinuses)?

From the Guidelines

The most effective antibiotic treatment for pediatric patients with acute sinusitis is amoxicillin alone or in combination with clavulanate, as it is the first-line antibiotic choice. This recommendation is based on the American Academy of Pediatrics (AAP) guideline on the diagnosis and management of acute bacterial sinusitis in children one to 18 years of age 1.

Key Considerations

• Antibiotics should be prescribed in children with severe, worsening, or persistent acute bacterial sinusitis.
• Outpatient observation for three days is also an option in children with persistent illness.
• For children who are vomiting, who cannot take oral medications, or who are not likely to take the initial antibiotic doses as prescribed, intravenous or intramuscular ceftriaxone (Rocephin) can be given.
• After clinical improvement, the treatment can be changed to oral therapy.

Alternative Options

• Children with hypersensitivity to amoxicillin (type 1 and non–type 1) can be treated with cefdinir (Omnicef), cefuroxime (Ceftin), or cefpodoxime.

Important Considerations

• Many cases of sinusitis in children are viral and will resolve without antibiotics.
• Bacterial sinusitis should be suspected if symptoms persist for more than 10 days, are severe, or worsen after initial improvement.
• Antibiotics should be prescribed judiciously to prevent antibiotic resistance, as stated in the AAP guidelineetiket 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. The most effective antibiotic treatment for pediatric patients with acute sinusitis is azithomycin at a dose of 10 mg/kg once daily for 3 days 2.

• The safety and effectiveness of azithromycin in pediatric patients with acute bacterial sinusitis under 6 months of age have not been established.
• Use of azithromycin for the treatment of acute bacterial sinusitis in pediatric patients (6 months of age or greater) is supported by adequate and well-controlled studies in adults, similar pathophysiology of acute sinusitis in adults and pediatric patients, and studies of acute otitis media in pediatric patients.

From the Research

Antibiotic Treatment for Pediatric Patients with Acute Sinusitis

The most effective antibiotic treatment for pediatric patients with acute sinusitis is a topic of discussion among medical professionals.

• The pathogens most commonly implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 3, 4, 5, 6.
• Amoxicillin is often used as first-line therapy for uncomplicated acute bacterial rhinosinusitis, with amoxicillin-clavulanate being an alternative for patients who are allergic to amoxicillin or have a high risk of antibiotic resistance 3, 4, 5, 6.
• For patients who do not respond to initial treatment, second-line antibiotics such as high-dose amoxicillin-clavulanate, cefdinir, or cefpodoxime may be considered 3, 4, 5.
• Azithromycin has been shown to be effective in the treatment of acute sinusitis in children, with a single daily dose of 10 mg/kg for three days being as effective as amoxicillin-clavulanate given three times a day for ten days 7.
• The optimal duration of antibiotic therapy is unknown, but treatment is typically continued until the patient is free of symptoms and then for an additional 7 days 4.

Choosing the Right Antibiotic

When choosing an antibiotic for the treatment of acute sinusitis in pediatric patients, several factors should be considered, including:

• The severity of the infection
• The patient's medical history and allergies
• The risk of antibiotic resistance
• The potential for side effects and interactions with other medications
• The cost and availability of the antibiotic 3, 4, 5, 6.

Diagnosis and Management

The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms 5, 6.

• Imaging is not indicated routinely in the diagnosis of sinusitis, but computed tomography or magnetic resonance imaging may be useful when complications of sinusitis are suspected 6.