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PEDIATRICS Vol. 108 No. 3 September 2001, pp. 798-808
AMERICAN ACADEMY OF PEDIATRICS:
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 analysis of the
medical literature. Expert consensus opinion was used to enhance or
formulate recommendations where data were insufficient.
A subcommittee, composed of pediatricians with expertise in infectious
disease, allergy, epidemiology, family practice, and pediatric
practice, supplemented with an otolaryngologist and radiologist, were
selected to formulate the practice parameter. Several other groups
(including members of the American College of Emergency Physicians,
American Academy of Otolaryngology-Head and Neck Surgery, American
Academy of Asthma, Allergy and Immunology, as well as numerous national
committees and sections of the American Academy of Pediatrics) have
reviewed and revised the guideline. Three specific issues 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 symptoms, 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 There were only 5 controlled randomized trials and 8 case series on
antimicrobial therapy for acute bacterial sinusitis in children.
However, these data, plus data derived from the study of adults with
acute bacterial sinusitis, support the recommendation that acute
bacterial sinusitis be treated with antimicrobial therapy to achieve a
more rapid clinical cure. Children with complications or suspected
complications of acute bacterial sinusitis should be treated promptly
and aggressively with antibiotics and, when appropriate, drainage.
Based on controversial and limited data, no recommendations are made
about the use of prophylactic antimicrobials, ancillary therapies, or
complementary/alternative medicine for prevention and treatment of
acute bacterial sinusitis.
This clinical practice guideline is not intended as a sole source of
guidance 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 judgment or establish a protocol for all patients with
this condition.
6 years of age who present
with upper respiratory symptoms that are either persistent or severe.
Although controversial, imaging studies may be necessary to confirm a
diagnosis of acute bacterial sinusitis in children >6 years of age.
Computed tomography scans of the paranasal sinuses should be reserved
for children who present with complications of acute bacterial
sinusitis or who have very persistent or recurrent infections and are
not responsive to medical management.
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