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Management Of Acute Rhinosinusitis In Pediatric Patients

May 2012

Abstract

Acute rhinosinusitis is a common illness that represents a substantial economic burden. Viral infection of the upper respiratory tract is the most common presentation of rhinosinusitis, and the vast majority of cases resolve spontaneously, with only a small proportion developing a secondary bacterial infection that will benefit from antimicrobial therapy. Accurate diagnosis of rhinosinusitis depends upon clinical assessment. Acute bacterial rhinosinusitis is generally diagnosed in the presence of more than 7 to 10 days of nasal discharge. The most common bacterial isolates from acute bacterial rhinosinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Group A beta-hemolytic streptococci, and Staphylococcus aureus. Anaerobes predominate in rhinosinusitis of dental origin, and fungi and Pseudomonas aeruginosa predominate in rhinosinusitis in neutropenic patients. The proper choice of antibiotic therapy depends on the likely infecting pathogens, bacterial antibiotic resistance, and the antibiotics’ pharmacologic profiles. Isolation of the causative agents should be considered in cases failing initial treatment. In addition to antibiotics, adjuvant therapies and surgery may be utilized in the management of bacterial sinusitis.

Keywords: pediatric rhinosinusitis, acute bacterial rhinosinusitis, sinusitis, microbiology of sinusitis, upper respiratory infection

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