Acute Bacterial Sinusitis in Children: Evaluation and Treatment

MAKING THE DIAGNOSIS
The diagnosis of ABS is a clinical one. Clinical guidelines from the AAP and IDSA for the diagnosis of ABS in children are very similar; both describe clinical presentations of persistent, severe, or worsening symptoms.^3,4 This display of expert consensus allows clinicians to confidently distinguish between viral URIs and ABS by adhering to the strict diagnostic criteria already discussed.

Imaging
Radiographs and CT scans are not necessary to confirm the diagnosis of ABS. Imaging studies may reveal current or recent upper respiratory symptoms, including mucosal inflammation, opacities, and air-fluid levels^6,7; however, no imaging study is available that can distinguish among mucosal inflammation and viral or bacterial infections. CT scans or MRI may be useful if clinicians suspect a complication of sinusitis.^3,7

Microbiology
Historically, the microbiology of ABS has been determined by maxillary sinus aspiration. The most recent studies of this method, published in the 1980s, identified Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis as the most common bacterial pathogens.^3,6,9 More recently, the microbiology of ABS has been linked with causative pathogens in AOM. The pathogenesis of ABS and AOM are similar, therefore allowing data from tympanocentesis in children with AOM to be used to determine the microbiology of children with ABS.¹⁰ Although S pneumoniae, H influenzae, and M catarrhalis remain common causative pathogens in ABS, the introduction of the 7- and 13-valent pneumococcal vaccines has altered the microbiology of AOM, and presumably ABS.¹¹

Importantly, numbers of cases of AOM attributed to S pneumoniae have decreased while those attributed to H influenzae have increased.^3,11 In addition, antimicrobial susceptibility of S pneumoniae and the prevalence of β-lactamase–positive H influenzae are important considerations when choosing appropriate antibiotics and can vary significantly by geographic region. Therefore, it is important that clinicians be aware of susceptibility patterns in the communities in which they practice.

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