Acute Bacterial Sinusitis

Acute bacterial sinusitis 

Diagnosed based on acute upper respiratory illness with: 

Persistent rhinorrhea or daytime cough lasting >=10 days and not improving  

OR 

Substantially worsening course after initial improvement 

OR 

Severe symptoms at onset:  

T >= 39C 

AND  

Purulent nasal discharge for at least 3 consecutive days 

Streptococcus pneumoniae 

Haemophilus influenzae 

Moraxella catarrhalis 

Recommend initial observation without antibiotic therapy if diagnosis is made only based on persistence of rhinorrhea or cough - many patients improve without antibiotic therapy 

Non-severe symptoms: 

Amoxicillin  
45 mg/kg/dose (max 1000 mg/dose)* enterally bid  

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Severe symptoms (see 1st  column): 

Amoxicillin-clavulanate (Augmentin)
45 mg amoxicillin/kg/dose (max 2000 mg amoxicillin/dose)*  enterally bid  

Penicillin allergy with lower risk for allergic reaction: 

Oral cephalosporin (follow link for options) 

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Penicillin allergy with higher risk for allergic reaction: 

Consult ID/ASP  

Azithromycin is not recommended for this indication. 

Duration: Typical treatment duration is 10 days 

*See guidance on maximum dosing of Amoxicillin and Amoxicillin-Clavulanate 

Refer to Intracranial Abscess section if intracranial complication or Orbital Cellulitis section if orbital extension