Rhinosinusitis in children: Update on etiology and treatment

In children, most cases of rhinosinusitis involve one of three bacteria, Streptococcus pneumoniae, Hemophilus influenzae, or Moraxella catarrhalis. However, multiple pathogens, including Staphylococcus aureus, Streptococcus pyogenes, anaerobes, gram-negative bacteria, fungi, and viruses may also be present. For treatment, amoxicillin alone is usually preferred. Where penicillin-resistant bacteria are highly prevalent, consider amoxicillin- clavulanate. Trimethoprimsulfamethoxazole, erythromycin-sulfisoxazole, cefuroxime axetil, cefpodoxime, and clarithromycin are suitable alternatives. Clinical improvement normally occurs within a few days. Depending on the rapidity of the clinical response, continue therapy for 2 to 3 weeks to avoid relapse. Complications involving the orbit or intracranial contents sometimes occur and are life-threatening.