Clinical practice guideline: Management of sinusitis

This clinical practice guideline formulates recommendations for health care providers regarding the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute bacterial sinusitis. It was developed through a comprehensive search and a nalysis of the medical literature. Expert consensus opinion was used to enh ance or formulate recommendations where data were insufficient. A subcommittee, composed of pediatricians with expertise in infectious dise ase, allergy, epidemiology, family practice, and pediatric practice, supple mented with an otolaryngologist and radiologist, were selected to formulate the practice parameter. Several other groups (including members of the Ame rican College of Emergency Physicians, American Academy of Otolaryngology-H ead and Neck Surgery, American Academy of Asthma, Allergy and Immunology, a s well as numerous national committees and sections of the American Academy of Pediatrics) have reviewed and revised the guideline. Three specific iss ues were considered: 1) evidence for the efficacy of various antibiotics in children; 2) evidence for the efficacy of various ancillary, nonantibiotic regimens; and 3) the diagnostic accuracy and concordance of clinical sympt oms, radiography (and other imaging methods), and sinus aspiration. It is recommended that the diagnosis of acute bacterial sinusitis be based on clinical criteria in children <6 years of age who present with upper res piratory symptoms that are either persistent or severe. Although controvers ial, imaging studies may be necessary to confirm a diagnosis of acute bacte rial sinusitis in children >6 years of age. Computed tomography scans of th e paranasal sinuses should be reserved for children who present with compli cations of acute bacterial sinusitis or who have very persistent or recurre nt infections and are not responsive to medical management. There were only 5 controlled randomized trials and 8 case series on antimic robial therapy for acute bacterial sinusitis in children. However, these da ta, plus data derived from the study of adults with acute bacterial sinusit is, support the recommendation that acute bacterial sinusitis be treated wi th antimicrobial therapy to achieve a more rapid clinical cure. Children wi th complications or suspected complications of acute bacterial sinusitis sh ould be treated promptly and aggressively with antibiotics and, when approp riate, drainage. Based on controversial and limited data, no recommendation s are made about the use of prophylactic antimicrobials, ancillary therapie s, or complementary/alternative medicine for prevention and treatment of ac ute bacterial sinusitis. This clinical practice guideline is not intended as a sole source of guidan ce in the diagnosis and management of acute bacterial sinusitis in children . It is designed to assist pediatricians by providing an analytic framework for evaluation and treatment. It is not intended to replace clinical judgm ent or establish a protocol for all patients with this condition.