Sinusitis in Children

Sinus Infection in Kids: What Parents Should Know

  • Sinusitis means infection and inflammation of the sinus cavities. The infections can be viral or bacterial and often follow colds or attacks of allergies.
  • Nine out of every ten cases of sinusitis are caused by viruses and do NOT get better with antibiotics.
  • 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.

Does your child need antibiotics for a sinus infection?

  • Infectious disease specialists agree on the following criteria for treating sinus infections with antibiotics:
    • Symptoms (nasal congestion, sinus pressure/headache, facial pain, sore throat, cough) lasting for 10 days or more and not improving
    • Symptoms (as above) with fever over 102 degrees lasting for 3-4 days in a row
    • Cold symptoms lasting 5-6 days that improved but were then followed by new fever, headache, cough, nasal discharge or facial pain
    • 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.
  • Adults meeting the criteria above can be treated with antibiotics for just 5-7 days. Children should still get 10-14 days of treatment.

Which antibiotics are best for sinus infections in children?

  • The antibiotic of choice for both children and adults who are not allergic to penicillin is amoxicillin with clavulanic acid (Augmentin™).
  • Azithromycin (Zithromax™, Z-pack™) is NOT recommended for sinusitis due to bacterial resistance.
  • 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™).
  • 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.
  • Oral decongestants are not recommended for the treatment of sinusitis. Antihistamines may be used if there are underlying seasonal/environmental allergies.
  • 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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