Pediatric Sinusitis – Hold Back On Antibiotics, New AAP Guidelines

The American Academy of Pediatrics (AAP) has just issued new guidelines for physicians diagnosing pediatric bacterial sinusitis and determining whether antibiotic treatment is necessary.

Acute bacterial sinusitis generally lasts up to a maximum of a month, it causes the patient’s sinuses to become inflamed and swollen, leading to a build up of mucus and making it hard to breathe.

The previous version of the AAP guideline was published in 2001. This new revised guideline, titled “Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years”, includes changes to help doctors make a more accurate diagnosis.

Michael Smith, MD, who wrote a new technical report on “criteria for diagnosis among children with an acute upper respiratory infection (AURI)”, a doctor can diagnose bacterial sinusitis if the child with AURI has symptoms that have lasted at least ten days, or a severe onset of symptoms, including nasal discharge lasting at least three consecutive days, and fever.

The AAP said that their new guidelines are based on an analysis of numerous studies since 2001. A total of 17 randomized studies of sinusitis in children were examined.

Imaging tests were not recommended by the AAP, and the guideline includes a new scenario for diagnosing acute bacterial sinusitis:

  • Nasal discharge
  • Cough – more than one-third of chronic cough patients given a CT scan had sinusitis in a previous Mayo Clinic study.
  • Fever following initial improvement

Only children with severe symptoms should receive antibiotic treatment. The guideline states that antibiotic therapy should only be used if symptoms of the condition continue to worsen 72 hours after their initial onset. This is in contrast to the 2001 guideline which recommended antibiotic therapy for all children diagnosed with the condition.

If necessary, first line treatment should be amoxicillin, which can be switched if the symptoms don not improve after 72 hours.

A previous review of clinical trials revealed that even though antibiotics can provide minor improvements in uncomplicated sinusitis cases, most patients recover without the drugs within two weeks.

According to authors of that study, led by Anneli Ahovuo-Saloranta of the Finnish Office for Health Technology, the health risks for the patient and society might override the benefits of antibiotics for people suffering with a simple sinus infection. Especially considering that the “overuse of antibiotics leads to antimicrobial resistance.”

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