With cold and flu season practically upon us, our dear friend and colleague Dr. Ellen Wald at the University of Wisconsin presents a timely review of acute bacterial sinusitis in this week’s New England Journal of Medicine:
KEY CLINICAL POINTS
ACUTE BACTERIAL SINUSITIS IN CHILDREN
• In most instances, acute bacterial sinusitis in children follows a viral upper respiratory infection.• Sinusitis in children has three predictable patterns of presentation: persistent, severe, and worsening symptoms.• The diagnosis of acute bacterial sinusitis should be made on the basis of the history, generally without the use of imaging studies.• Haemophilus influenzae appears to have become more common and Streptococcus pneumoniae less common as causes of acute bacterial sinusitis in children.• Rates of beta-lactamase production in H. influenzae have increased in many geographic areas.
• Studies of the use of antimicrobial agents have had conflicting results, but findings generally support treatment.
• Amoxicillin–clavulanate should be considered as the first-line treatment for sinusitis in children.