rhinosinusitis%20-%20acute,%20bacterial%20(pediatric)
RHINOSINUSITIS - ACUTE, BACTERIAL (PEDIATRIC)
Treatment Guideline Chart
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.

Rhinosinusitis%20-%20acute,%20bacterial%20(pediatric) Signs and Symptoms

Definition

  • Acute rhinosinusitis is defined as sudden onset of ≥2 of the following symptoms for <12 weeks:
    • Nasal blockage/obstruction/congestion
    • Discolored nasal discharge
    • Daytime or night-time cough
    • Facial pressure or pain
  • Acute bacterial rhinosinusitis is defined as 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
  • Often preceded by a viral upper respiratory tract infection (URTI)
    • It is a common complication of viral URTI or allergic inflammation

Etiology

  • Streptococcus pneumoniae is the most common cause followed by nontypeable Haemophilus influenzae
  • 3rd most common pathogen is Moraxella catarrhalis
  • Streptococcus pyogenes, respiratory anaerobes, Staphylococcus aureus are less common bacterial causes

Signs and Symptoms

  • Signs and symptoms are nonspecific and it is typically difficult to differentiate from viral upper respiratory infection (URTI)
  • Major symptoms include anterior and/or posterior mucopurulent drainage, nasal obstruction, facial pressure/pain/fullness, hyposmia/anosmia, and fever
  • Less common signs and symptoms include fatigue, headache, ear pressure/discomfort, halitosis, cough, and maxillary dental pain

Risk Factors

  • Most common predisposing factors are viral upper respiratory tract infection (URTI) and allergic inflammation
  • Other predisposing factors
    • Anatomic (eg nasal foreign bodies, septal deviation, tumor, trauma)
    • Inflammatory [eg gastroesophageal reflux disease (GERD), allergic rhinitis, vasomotor rhinitis, granulomatosis with polyangiitis]
    • Systemic (eg cystic fibrosis, immunodeficiencies, primary ciliary dyskinesia, Kartagener syndrome)
    • Iatrogenic (eg sinus surgery, nasogastric tubes, nasal packing, mechanical ventilation)
    • Other factor (eg exposure to cigarette smoking)

 Recent Antibiotic Use

  • Recent antibiotic use (<90 days) is a major risk factor associated with increased risk of carriage and infection due to resistant pathogens

Other Risk Factors For Resistant Pathogens

  • Age <2 years
  • Attendance in daycare centers
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