From the Guidelines
The patient should be treated with a non-penicillin and non-cephalosporin antibiotic, such as clindamycin or a fluoroquinolone, due to the allergy to cefdinir and Penicillin (PCN).
Treatment Options
- Clindamycin: is a suitable option for treating acute bacterial sinusitis in children with an allergy to penicillin and cefdinir, as it covers penicillin-resistant S pneumoniae 1.
- Levofloxacin: is another option, although its use in children is limited due to concerns about adverse effects on developmental joint formation, it can be considered in severe cases 1.
Initial Management
The initial management of the patient should follow the guidelines for acute bacterial sinusitis, which include:
- Assessing the severity of the illness: and determining the need for antibiotic therapy 1.
- Choosing an appropriate antibiotic: based on the patient's allergy history and the suspected pathogens 1.
- Monitoring for improvement: and adjusting the treatment plan as needed 1.
Important Considerations
- Allergy history: is crucial in determining the appropriate antibiotic therapy, and alternative options should be considered in cases of allergy to penicillin and cefdinir 1.
- Local resistance patterns: should be taken into account when selecting an antibiotic, as the prevalence of resistant organisms can vary by region 1.
- Duration of therapy: is not well defined, but a 10- to 14-day course of antibiotic may be adequate for most patients with acute disease 1.
From the Research
Treatment Options for Sinusitis in a 5-year-old Patient with Allergy to Cefdinir and Penicillin (PCN)
- The patient's allergy to cefdinir and PCN limits the treatment options for sinusitis 2, 3, 4.
- According to the studies, alternative antibiotics that can be used in patients with PCN allergy include:
- Clarithromycin or azithromycin 2, 3, 4.
- Clindamycin may also be indicated as first-line treatment in patients who have culture-proven penicillin-resistant S. pneumoniae 3.
- High-dose amoxicillin-clavulanate (90 mg/kg/d of the amoxicillin component) may be used in high-risk children, but this may not be suitable for patients with a PCN allergy 3.
- The choice of antibiotic should be based on the suspected or confirmed causative pathogen, as well as the patient's allergy history and other medical conditions 3, 5.
- The optimal duration of therapy is unknown, but some studies recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 2, while others recommend 10-14 days of antibiotic therapy 4.
Considerations for Pediatric Patients
- In pediatric patients, the diagnosis of acute bacterial rhinosinusitis (ABRS) can be challenging due to similar symptoms with viral upper respiratory tract infections 3, 4.
- The 2013 American Academy of Pediatrics (AAP) guidelines for the diagnosis and management of ABRS in children should be followed 4.
- ENT providers may use nasal cultures to guide antibiotic therapy, and may prescribe different antibiotics, such as clarithromycin or Bactrim, compared to primary care providers 4.