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AAP Updates Guidelines for Bacterial Sinusitis in Children

Changes include provisions for worsening course, guidance against imaging in uncomplicated cases

MONDAY, June 24 (HealthDay News) -- The American Academy of Pediatrics (AAP) has updated its recommendations for the diagnosis and management of acute bacterial sinusitis in children; the updated clinical practice guideline has been published online June 24 in Pediatrics.

Ellen R. Wald, M.D., chair of AAP's subcommittee on acute sinusitis, and colleagues assessed the medical literature since the last guideline was published on the topic in 2001.

The authors state that distinguishing between acute bacterial sinusitis and viral upper respiratory tract infection using imaging studies is not necessary as it does not further the diagnosis. However, whenever a child is suspected of having orbital or central nervous system complications, a contrast-enhanced computed tomography scan of the paranasal sinuses should be ordered. In cases of severe onset or worsening course, antibiotic therapy should be prescribed for acute bacterial sinusitis in children. For children with persistent illness, the clinician should either prescribe antibiotic therapy or offer additional observation for three days. For the first-line treatment of acute bacterial sinusitis, clinicians should prescribe amoxicillin with or without clavulanate. Initial management should be reassessed if there is either a caregiver report of worsening (progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours.

"Changes in this revision include the addition of a clinical presentation designated as 'worsening course,' an option to treat immediately or observe children with persistent symptoms for three days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis," the authors write.

Abstract (http://pediatrics.aappublications.org/content/early/2013/06/19/peds.2013-1071.abstract )Full Text (http://pediatrics.aappublications.org/content/early/2013/06/19/peds.2013-1071.full.pdf+html )