- 6 yr ols is seen in opd with fever ,headache, vomiting of 4 days duration. there is no h/o cold,day time cough. fever was of low grade with no nasal discharge . he was dx as pansinusitis and given azithromycin. is the management on current clinical guidelines?
- Clinicians should make a presumptive diagnosis of acute bacterialsinusitis when a child with an acute URI presents with the following: Persistent illness, ie, nasal discharge (of any quality) or daytimecough or both lasting more than 10 days without improvement; OR Worsening course, ie, worsening or new onset of nasal discharge, daytime cough, orfever after initial improvement; OR Severe onset, ie, concurrent fever (temperature ≥39°C/102.2°F) and purulent nasal discharge for at least 3 consecutive days (Evidence Quality: B; Recommendation).
Clinicians should not obtain imaging studies (plain films, contrastenhancedcomputed tomography [CT], MRI, or ultrasonography) to distinguish acute bacterial sinusitisfrom viral URI (Evidence Quality:B; Strong Recommendation).
- “Severe onset and worsening course” acute bacterial sinusitis.The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course (signs, symptoms, or both) (Evidence Quality: B; Strong Recommendation).
- “Persistent illness.” The clinician should either prescribe antibiotic therapy OR offer additional outpatient observation for 3 daysto children with persistent illness(nasal discharge of any quality or cough or both for at least 10 dayswithout evidence of improvement)(Evidence Quality: B; Recommendation).
Clinicians should prescribe amoxicillin with or without clavulanateas first-line treatment when a decision has been made to initiateantibiotic treatment of acute bacterialsinusitis (Evidence Quality: B; Recommendation).
- Clinicians should prescribe amoxicillin with or without clavulanateas first-line treatment when a decision has been made to initiate antibiotic treatment of acute bacterial sinusitis (Evidence Quality: B; Recommendation
Clinicians should reassess initial management if there is eithera caregiver report of worsening(progression of initial signs/symptoms or appearance of newsigns/symptoms) OR failure oimprove (lack of reduction in all presenting signs/symptoms)within 72 hours of initial management (Evidence Quality: C; Recommendation).
If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve in 72 hours, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic OR initiate antibiotic treatment of the child initially managed with observation (Evidence Quality: D; Option based on expert opinion, case reports, and reasoning from first principles
Dr. Jayaprakash
Superintendent, ICH.
Institute of Child Health.
Gov. Medical College Kottayam.
Kerala, India.