Recommendations for Initial Use of Antibiotics for Acute Bacterial Sinusitis
| Clinical Presentation . | Severe Acute Bacterial Sinusitisa . | Worsening Acute Bacterial Sinusitisb . | Persistent Acute Bacterial Sinusitisc . |
|---|---|---|---|
| Uncomplicated acute bacterial sinusitis without coexisting illness | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy or additional observation for 3 daysd |
| Acute bacterial sinusitis with orbital or intracranial complications | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy |
| Acute bacterial sinusitis with coexisting acute otitis media, pneumonia, adenitis, or streptococcal pharyngitis | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy |
| Clinical Presentation . | Severe Acute Bacterial Sinusitisa . | Worsening Acute Bacterial Sinusitisb . | Persistent Acute Bacterial Sinusitisc . |
|---|---|---|---|
| Uncomplicated acute bacterial sinusitis without coexisting illness | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy or additional observation for 3 daysd |
| Acute bacterial sinusitis with orbital or intracranial complications | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy |
| Acute bacterial sinusitis with coexisting acute otitis media, pneumonia, adenitis, or streptococcal pharyngitis | Antibiotic therapy | Antibiotic therapy | Antibiotic therapy |
Defined as temperature ≥39°C and purulent (thick, colored, and opaque) nasal discharge present concurrently for at least 3 consecutive days.
Defined as nasal discharge or daytime cough with sudden worsening of symptoms (manifested by new-onset fever ≥38°C/100.4°F or substantial increase in nasal discharge or cough) after having experienced transient improvement of symptoms.
Defined as nasal discharge (of any quality), daytime cough (which may be worse at night), or both, persisting for >10 days without improvement.
Opportunity for shared decision-making with the child’s family; if observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens at any time or fails to improve within 3 days of observation.