Acute Bacterial Sinusitis

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Amoxicillin with or without clavulanate is the first line treatment for acute bacterial sinusitis in children. Observation may be an option when the diagnosis is made on the basis of persistent symptoms.

Acute bacterial sinusitis can be a difficult diagnosis in children. The diagnosis can be made in one of the three following situations:

  1. Persistent symptoms -Nasal discharge or daytime cough or both lasting more than 10 days without improvement.
  2. Worsening symptoms - Worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement.
  3. Severe onset - Acute onset of fever ≥39°C and purulent nasal discharge for at least 3 consecutive days.

In the case of persistent symptoms both antibiotic therapy or observation may be options. Antibiotic therapy is recommended if the diagnosis is made based on worsening symptoms or severe onset.

The pathogen are similar to those in otitis media with Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis being most commonly isolated in studies that did maxillary sinus aspiration.

The first line antibiotics are Amoxicillin and Amoxicillin with Clavulanate. IDSA guidelines recommend Amoxicillin with clavulanate for all children while AAP guidelines recommend this only for children with more severe symptoms, complications or higher risk or resistance such as those in childcare, those with recent antibiotics and those younger than two years of age.


Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul;132(1):e262-80. PMID: 23796742

Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112. PMID: 22438350