How do we treat acute bacterial
sinusitis in children?

What kind of symptoms do they have?

Acute Severe

UNKNOWN: Does the presentation type have anything to do with the bacteria causing symptoms? Should each presentation be treated differently?

Worsening

Chronic

Produce beta-lactamase

Amoxicillin-clavulanate

What drug you prescribe?

Amoxicillin-clavulanate

Clinical Indications?

Conjunctivitis?

Failed amoxicillin?

Amoxicillin

How long to treat?

Amoxicillin

Following Prevnar (anti-pneumococcal vaccine), is this still the most common cause of sinusitis?

Based on presumption that Prevnar reduced pneumococcus and proportionately increase Moraxella/Haemophilus, Infectious Disease Society of America guidelines recommend amoxicillin-clavulanate for first line treatment. Because there is no evidence that this shift in bacteria has occurred, American Academy of Pediatrics guidelines recommend amoxicillin. See Chow, et al, Clinical Infectious Disease 2012 and Wald, et al, Pediatrics 2013.

Adverse Events

Antibiotic Resistance

Outpatient Antimicrobial Stewardship is essential (Click here to link to CDC for more info)

C difficile /
antibiotic associated diarrhea

Cost

Floating topic

Example: Do you treat a 12 year old boy with 3 weeks of symptoms differently than a 6 year with sudden onset of severe symptoms?

Example: My 5 year old had a high fever, profuse, purulent rhinorrhea and pink eye. He just finished amoxicillin for an ear infection a week ago. Should you prescribe amoxicillin or amoxicillin-clavulanate?

The many "UNKNOWN" outstanding questions are examples of opportunities for outpatient clinical research in pediatric offices.