What is the treatment for acute sinusitis in children with symptoms lasting 1.5 weeks?

From the Guidelines

For acute sinusitis in children with 1.5 weeks of symptoms, the recommended approach is to either prescribe antibiotic therapy or offer additional observation for 3 days, as the symptoms have persisted for more than 10 days without improvement. The diagnosis of acute bacterial sinusitis is made when a child presents with persistent illness, worsening course, or severe onset 1. Supportive measures such as saline nasal irrigation, adequate hydration, acetaminophen or ibuprofen for pain and fever, and possibly intranasal corticosteroids like fluticasone can be used to manage symptoms.

• Key considerations for treatment include:
  • Antibiotic therapy should be prescribed for children with severe onset or worsening course of acute bacterial sinusitis 1.
  • Amoxicillin with or without clavulanate is the first-line treatment for acute bacterial sinusitis, with the dosage depending on the severity of the illness and the presence of risk factors for resistant bacteria 1.
  • Children with penicillin allergies can be treated with alternative antibiotics such as cefdinir, cefuroxime, or clindamycin plus cefixime 1.
  • The treatment should be reassessed if there is no improvement within 72 hours of initial management, and the antibiotic therapy may be changed or initiated if necessary 1.
  • Referral to an otolaryngologist may be warranted if symptoms persist beyond 4 weeks to rule out complications or chronic sinusitis. The approach is based on the fact that most acute sinusitis cases in children are viral and resolve spontaneously, while unnecessary antibiotic use contributes to resistance and side effects 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 recommended treatment for acute sinusitis in children with 1.5 weeks of symptoms is 10 mg/kg once daily for 3 days of azithromycin.

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

• 5-10 kg: 2.5 mL (1/2 tsp) per day
• 10-20 kg: 5 mL (1 tsp) per day
• 20-30 kg: 7.5 mL (1 ½ tsp) per day
• 30-40 kg: 10 mL (2 tsp) per day
• 40-50 kg: 12.5 mL (2 ½ tsp) per day
• 50 kg and above: 12.5 mL (2 ½ tsp) per day 2

From the Research

Treatment Options for Acute Sinusitis in Children

• The treatment for acute sinusitis in children with 1.5 weeks of symptoms can be approached with various antibiotic options, including azithromycin and amoxicillin-clavulanate 3, 4, 5, 6.
• A study comparing azithromycin and amoxicillin-clavulanate in children with acute sinusitis found that azithromycin in a single daily dose of 10 mg/kg for three days showed the same efficiency as amoxicillin-clavulanate given three times per day in a dose of 45 mg/kg for ten days 3.
• Another study in adults, but relevant for comparative purposes, found that a single 2-g dose of azithromycin extended release had a higher rate of symptom resolution at day 5 compared to 10 days of amoxicillin/clavulanate 875 mg/125 mg every 12 hours in patients with acute sinusitis 4.
• The choice between azithromycin and amoxicillin-clavulanate may depend on factors such as the simplicity of the dosage regimen, potential for gastrointestinal side effects, and the specific clinical presentation of the patient 5, 6.
• It's worth noting that while the provided studies offer insights into the treatment of acute sinusitis, the specific context of children with 1.5 weeks of symptoms may require consideration of additional factors, including the potential for bacterial resistance and the need for careful diagnosis to ensure appropriate treatment 3, 4, 5, 6.

Considerations for Treatment

• The decision to use azithromycin or amoxicillin-clavulanate should be based on clinical judgment, considering the severity of symptoms, the likelihood of bacterial infection, and the potential risks and benefits of each antibiotic option 3, 4, 5, 6.
• Studies in adults have shown that azithromycin can be an effective and well-tolerated option for the treatment of acute sinusitis, with advantages including a simpler dosage regimen and potentially fewer gastrointestinal side effects compared to amoxicillin-clavulanate 4, 5, 6.
• However, the effectiveness of amoxicillin versus amoxicillin-clavulanate in adults with acute sinusitis has also been compared, with findings suggesting that amoxicillin may be a viable option with fewer gastrointestinal-related adverse events 7.