New Guidelines for Treating Sinus Infections

Kids get runny noses. But is it caused by allergies, a simple cold or something more serious like a sinus infection? If your child has a history of sinus infections, a new review of clinical guidelines may be just what the doctor ordered.

A recent review of the research looked at the most current studies related to acute bacterial sinusitis in children.

The review offers physicians new guidelines for treating sinusitis in children. In the new guidelines, doctors may wait up to three days before beginning treatment with antibiotics and are discouraged from giving children x-rays.

The study, written by Michael J. Smith, MD, from the University of Louisville School of Medicine, reviewed the most recently published research available for treating bacterial sinusitis in children.

Smiths research led to several changes in guidelines for treatment.

Children can contract viral sinusitis or bacterial sinusitis. Viral sinusitis usually develops when a child has a cold or allergies.  Bacterial sinusitis tends to make a child feel sicker than viral sinusitis. A child with bacterial sinusitis usually will have more facial pain and swelling than someone with viral sinusitis, and might also develop a fever. Acute bacterial sinusitis is usually diagnosed when a child with an upper respiratory infection improves then spirals downward with worsening symptoms.  Five to ten percent of children with an upper respiratory infection develop acute bacterial sinusitis.

Dr. Smith looked for all randomized, controlled trials that had been published since 2001, when the last guidelines were published.

He located 17 studies that related specifically to treating acute bacterial sinusitis in children.

The current recommended treatment in the new guidelines is prescribing the antibiotic amoxicillin.

Doctors should prescribe this antibiotic if a child comes in with very severe symptoms of sinusitis (a runny nose with non-clear mucus and a fever over 102 Fahrenheit for at least three days).

If a child has a runny nose, cough and minor fever for more than 10 days, doctors can treat the child right away or, with the parents' input, wait up to three days to prescribe antibiotics, according to the new clinical guidelines.

The new guidelines that came from this systematic review recommend that doctors do not give children x-rays.

The new guidelines also suggest that children who get better at first and then have worse symptoms (acute bacterial sinusitis) should be treated right away.

The review and guidelines were published in the June journal of Pediatrics.

The signs and symptoms of bacterial sinusitis are:

- A stuffy or runny nose with a daytime cough that lasts for 10 to 14 days or longer without improvement

- Continuous thick green mucus discharge from the nose (sometimes with post nasal drip).

- Persistent dull pain or swelling around the eyes.

- Tenderness or pain in or around the cheekbones.

- A feeling of pressure in your head.

- A headache when you wake up in the morning or when bending over.

- Bad breath even after brushing your teeth.

- Pain in the upper teeth.

- A fever greater than 102F (39C).

Some of the symptoms listed above are the same as viral sinusitis, so its really best to take your child to his or her pediatrician or family doctor for a correct diagnosis.

Sources: Dominique Brooks,

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