From the Guidelines
For acute sinusitis in an 11-year-old, the most appropriate initial management is supportive care, including saline nasal sprays, adequate hydration, and acetaminophen or ibuprofen for pain and fever, with antibiotics considered if symptoms persist or worsen, as recommended by the American Academy of Pediatrics 1. The diagnosis of acute bacterial sinusitis is made when a child presents with persistent illness, worsening course, or severe onset, and clinicians should not obtain imaging studies to distinguish acute bacterial sinusitis from viral URI, unless there are suspected orbital or central nervous system complications 1.
- Supportive care includes:
- Saline nasal sprays to moisturize nasal passages and help clear mucus
- Adequate hydration to thin out mucus
- Acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) for pain and fever relief
- A warm compress applied to the face for comfort
- Antibiotics may be needed if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, with amoxicillin being the first-line antibiotic (40-45 mg/kg/day divided twice daily for 10-14 days) 1.
- For children with penicillin allergy, alternatives include azithromycin or clarithromycin, and decongestants should be avoided in children due to limited evidence of benefit and potential side effects 1.
- Intranasal steroids like fluticasone may help reduce inflammation but should be used under medical guidance, and the treatment of patients with presumed allergy to penicillin has been controversial, but recent publications indicate that the risk of a serious allergic reaction to second- and third-generation cephalosporins in patients with penicillin or amoxicillin allergy appears to be almost nil 1. The optimal duration of antimicrobial therapy for patients with acute bacterial sinusitis has not received systematic study, but recommendations based on clinical observations have varied widely, from 10 to 28 days of treatment, with an alternative suggestion being to continue antibiotic therapy for 7 days after the patient becomes free of signs and symptoms 1.
From the FDA Drug Label
Based on the amoxicillin component, amoxicillin and clavulanate potassium should be dosed as follows: Patients Aged 12 weeks (3 months) and Older: See dosing regimens provided in Table 1. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours
For an 11-year-old child with acute sinusitis, the treatment option is amoxicillin-clavulanate. The recommended dose is 45 mg/kg/day every 12 hours using the 200 mg/5 mL or 400 mg/5 mL oral suspension, based on the severity of the infection 2.
From the Research
Treatment Options for Acute Sinusitis in Children
The treatment options for acute sinusitis in an 11-year-old child include:
- Antibiotic therapy, with the choice of antibiotic depending on the likely infecting pathogens, bacterial antibiotic resistance, and pharmacologic profiles of antibiotics 3, 4
- Adjuvant therapies, such as analgesics, intranasal corticosteroids, and saline nasal irrigation, to treat symptoms 5
- Surgery, which may be used in the management of acute bacterial rhinosinusitis in some cases 4
Antibiotic Therapy
The following antibiotics may be used to treat acute sinusitis in children:
- Amoxicillin or amoxicillin-clavulanate as first-line therapy 3, 5, 4
- Cefuroxime, cefpodoxime, or cefdinir as alternative options 3
- Clarithromycin or azithromycin in cases of serious drug allergy 3
Duration of Therapy
The optimal duration of antibiotic therapy for acute sinusitis is unknown, but treatment is typically continued until the patient becomes free of symptoms and then for an additional 7 days 3. Some studies suggest that short-course antibiotic therapy (less than or equal to 5 days) may be equivalent or superior to traditional longer therapies (10-14 days) 6. However, further research is needed to determine the optimal duration of therapy in children 6.