rhinosinusitis%20-%20acute,%20bacterial%20(pediatric)
RHINOSINUSITIS - ACUTE, BACTERIAL (PEDIATRIC)
Rhinosinusitis is the mucosal inflammation of the nose and paranasal sinuses caused by bacteria lasting >10 days for up to 4 weeks, symptoms resolve completely and may either be persistent or severe.
It is often preceded by a viral upper respiratory tract infection.
Signs & symptoms are nonspecific and it is typically difficult to differentiate from viral upper respiratory tract infection.
Streptococcus pneumoniae is the most common cause followed by nontypeable Haemophilus influenzae.

Specialist Referral

  •  Indications for specialist referral (eg infectious disease specialist, allergologist, or otorhinolaryngologist):
    • Severe infection
    • Recalcitrant infection unresponsive to extended antibiotic therapy
    • Immunocompromised patients with recurrent episodes of rhinosinusitis
    • Presence of comorbidities that may affect treatment response
    • Resistant pathogens
    • Recurrent episodes (3-4x/year) suggesting chronicity of disease with accompanying exacerbations
    • Evaluation of possible anatomical abnormalities causing obstruction that may need surgery
    • Fungal sinus infection or granulomatous disease
    • Nosocomial infection
    • For evaluation of possible immunotherapy for patients with allergic rhinitis
  • Otolaryngology consultation is recommended in moderately to severely ill patients suspected of acute frontal or sphenoid sinusitis because of possible intracranial spread & in patients who do not improve after adequate medical therapy
    • Referral is also needed for possible maxillary sinus aspiration for culture & sensitivity so that therapy may be adjusted correctly
  • Referral to an otolaryngologist &/or ophthalmologist is indicated when signs of impending suppurative complications are present
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