Official reprint from UpToDate®

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Suggested approach to empiric antimicrobial therapy for outpatient treatment of

uncomplicated acute bacterial rhinosinusitis (ABRS) in children*

IM: intramuscularly.
* Inpatient therapy is indicated for patients who have toxic-appearance (eg, lethargy, poor perfusion, cardiorespiratory compromise) and
complications or suspected complications. If a pathogen is identified, antimicrobial therapy should be adjusted according to susceptibilities.
¶ Complications of ABRS include: preseptal and orbital cellulitis; subperiosteal abscess (orbital or frontal [Pott puffy tumor]); epidural,
subdural, or brain abscess; septic cavernous sinus thrombosis, and meningitis. Complicated sinusitis should be suspected in children with:
◾ The combination of periorbital/orbital swelling with persistent headache and vomiting
◾ Vomiting and headache that requires hospital admission, particularly in older children
◾ Vomiting that persists for more than 24 hours
◾ Altered level of consciousness
 ◾ Focal neurologic deficits
◾ Signs of meningeal irritation (eg, stiff neck)
Δ Refer to UpToDate topic on treatment of acute bacterial rhinosinusitis in children for details.
◊ Refer to UpToDate topics on penicillin allergy and cephalosporin allergy for details.
§ Risk factors for antimicrobial resistance:
◾ Living in an area with high endemic rates (ie, ≥10 percent) of invasive penicillin nonsusceptible Streptococcus pneumoniae
◾ Age <2 years
◾ Daycare attendance
◾ Antibiotic therapy within the past month
◾ Hospitalization within the past five days
◾ Unimmunized or underimmunized with pneumococcal conjugate vaccine
¥ If vomiting precludes administration of oral antibiotics, can administer ceftriaxone 50 mg/kg IM for one dose (maximum dose 1 g),
followed by amoxicillin-clavulanate, cefpodoxime, or cefdinir 24 hours later.
‡ If vomiting precludes administration of oral antibiotics, admit patient for parenteral therapy until vomiting resolves.

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