Sinusitis in Children

Sinus Infection in Kids: What Parents Should Know

 

  1. Sinusitis means infection and inflammation of the sinus cavities. The infections can be viral or bacterial and often follow colds or attacks of allergies.
  2. Nine out of every ten cases of sinusitis are caused by viruses and do not get better with antibiotics.
  3. Yellow or green mucus coming from the nose does NOT mean there’s a bacterial infection. This commonly occurs with viruses as well. Sinus pressure/headaches also do not mean there is a bacterial infection.
  4. Infectious disease specialists agree on the following criteria for treating sinus infections with antibiotics:
  5. Symptoms (nasal congestion, sinus pressure/headache, facial pain, sore throat, cough) lasting for 10 days or more and not improving
  6. Symptoms (as above) with fever over 102 degrees lasting for 3-4 days in a row
  7. Cold symptoms lasting 5-6 days that improved but were then followed by new fever, headache, cough, nasal discharge or facial pain
  8. Xrays are NOT accurate for diagnosing sinusitis. They can result in both under-diagnosis and over-diagnosis. The best test to detect the presence of infection is a CT scan of the sinuses.
  9. Adults meeting the criteria above can be treated with antibiotics for just 5-7 days. Children should still get 10-14 days of treatment.
  10. The antibiotic of choice for both children and adults who are not allergic to penicillin is amoxicillin with clavulanic acid (Augmentin™).
  11. Azithromycin (Zithromax™, Z-pack™) is NOT recommended for sinusitis due to bacterial resistance.
  12. Cefinir (Omnicef™) and other cephalosporins are NOT recommended for sinusitis except in combination therapy with clindamycin for children with non-life- threatening allergic reactions to penicillin. In these cases, the cephalosporin of choice is cefixime (Suprax™).
  13. Levofloxacin (Levaquin™) or doxycycline are the recommended antibiotics for adults with true penicillin allergies. Levofloxacin can also be considered for the treatment of children with life-threatening allergic reactions to penicillin. Doxycyline is not for use in children.
  14. Oral decongestants are not recommended for the treatment of sinusitis. Antihistamines may be used if there are underlying seasonal/environmental allergies.
  15. Nasal steroid sprays and nasal saline flushes can be helpful for sinusitis.

 

Lou Romig, MD, FAAP, FACEP, Medical Director

After Hours Pediatrics Urgent Care

 

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