Pediatric Guidelines: Respiratory Infections - Acute Bacterial Sinusitis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

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 onset

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Consider initial observation without antibiotic therapy for 72 hours if diagnosis is made only based on persistence of rhinorrhea or cough - many of these patients improve without antibiotic therapy

Non-severe infection:

Amoxicillin 45mg/kg/dose PO BID (max 1000mg/dose)*

Non-severe penicillin allergy:

Cefdinir 7mg/kg/dose PO BID (max 600mg/day)

Duration of beta lactam therapy:

10-14 days depending on symptom severity and course

*Click here for guidance on maximum dosing of Amoxicillin and Amoxicillin-Clavulanate

Severe penicillin allergy:

Consult ID/ASP

Severe infection:

Amoxicillin-clavulanate 45mg/kg/dose amoxicillin PO BID (max 2000mg amoxicillin/dose)*

Reference: Wald, ER, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013;132:e262-e280.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).