Additional symptoms such as recurrent illness, worsening course, and severe onset of symptoms were added on the new guidelines for diagnosing acute bacterial sinusitis on kids. This was confirmed by the American Academy of Pediatrics (AAP).
The recommendations for changes came from a research team headed by Ellen Wald, MD, chair of the AAP subcommittee on acute sinusitis. They conducted a study which concluded that imaging is unnecessary for children with uncomplicated acute bacterial sinusitis. They also limited the use of antibiotics to those with severe conditions only as other non-antibiotic alternatives produce same results.
Doctors are now required to include the following on their diagnosis: nasal discharge of any kind or cough that persist up to 10 days, worsening course with fever, and severe onset with coexisting fever and smelly nasal discharge for 3 consecutive days.
Doctors should also not use imaging studies such as plain films, contrast-enhanced scans to discern bacterial sinusitis from viral URI as they do not add to the diagnosis. However, they could use enhanced computed tomography scan of the paranasal sinuses if they suspect that the kid has orbital or central nervous system complications.
Antibiotics such as amoxicillin will be given only those with severe onset conditions. This is a significant change from the 2001 guidelines where children with acute bacterial sinusitis were given antibiotics. The research team conducted a test of using other nonpharmaceutical treatment on these patients and proved that it gave similar results thus antibiotics are not necessary. However, they should reassess the condition if it worsens in 3 days.
The AAP clarified that the changes on the guidelines are only for acute bacterial sinusitis.
Sinusitis in children is different than that of adults. Children more often experience cough, bad breath, irritability, fatigue, and swelling around the eyes, along with a thick yellow-green nasal or post-nasal discharge.
