New Guidelines to Treat Sinus Infections in Kids

Concern over antibiotic resistance seen in guidelines

child taking medicine

The runny nose, cough, headache, fever and discomfort of acute sinusitis can be tough on your child —  and on you as parents.

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The first thing many parents think of? Get the kid some antibiotics.

But sometimes antibiotics aren’t appropriate. Diagnosing bacterial sinusitis in children can be difficult. The symptoms may not be from bacterial sinusitis but from a viral illness or even from an allergy.

New guidelines give pediatricians more options

There is growing concern that antibiotics are over-prescribed and sometimes unnecessary. Antibiotics can cause side effects such as upset stomach and diarrhea, but the greater fear is the chance the child will develop antibiotic resistance.

Now there are a new set of guidelines from the American Academy of Pediatrics to help pediatricians diagnose sinusitis and determine when antibiotics are warranted, recommending an additional few days of watching and waiting. Sinusitis will often resolve on its own.

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Kim Giuliano, MD, did not help develop the guidelines but is a pediatrician at Cleveland Clinic Children’s.

“What’s new about these guidelines is they also give us the option — if the symptoms aren’t too severe — to wait a few more days before starting antibiotics,” says Dr. Giuliano.

New guidelines allow more leeway before antibiotic therapy

The guidelines are updates from those developed in 2001 that stated a diagnosis of bacterial sinusitis could be made when a child with an acute upper respiratory infection has symptoms lasting more than 10 days. Or it could be diagnosed if the child has a severe onset of symptoms including fever and nasal discharge lasting at least three days in a row.

The 2001 guidelines recommended antibiotic therapy for all children diagnosed with bacterial sinusitis. The updated, 2013 guidelines allow doctors to observe children with persistent illness lasting more than 10 days for an additional three days before making the decision to start antibiotics.

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Parents and pediatricians can work together

Dr. Giuliano says parents and pediatricians should work together on the decision to start a child on antibiotics or let the infection takes its course, keeping the child more comfortable through home treatment and milder medications.

“If the parents have concerns and think the child may potentially need antibiotics, by all means bring them to the doctor’s office,” says Dr. Guiliano. “We may or may not decide to do antibiotics. But it’s always good to have kids checked if parents have concerns.”

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