Doctors don't have to automatically prescribe an antibiotic to treat children
who appear to have acute sinus infections, according to new guidelines issued by
a leading group of paediatricians.
Instead, they can take a "watch and wait" approach if it appears the
infection might clear on its own, according to the new American Academy of
"The practitioner can either treat it immediately or consider waiting for a
couple of days," said Dr Ellen Wald, chairwoman of the academy's subcommittee on
acute sinusitis. "If the kid doesn't look dramatically ill, you can wait an
extra couple of days to see if they improve on their own."
The previous guidelines, passed in 2001, recommended antibiotic therapy for
all children diagnosed with acute bacterial sinusitis, which is defined as
persistent signs of sinus infection lasting more than 10 days.
Doctors now can observe kids for up to an additional three days past that
10-day period to see if their symptoms will ease without antibiotic
"There's nothing absolutely sacred about 10 days. It could be 11 days. It
could be 12 days," said Wald, chairwoman of paediatrics at the University of
Wisconsin School of Medicine and Public Health, in Madison. "In the child who
looks sicker, we wouldn't do that. We would start on antibiotics
The new guidelines, published online June 24 in the journal
Pediatrics, are driven primarily by concern over antibiotic resistance,
she said. There is a lot of overlap between the common cold and acute sinusitis,
and some children who are not suffering from a bacterial infection may be
"If we prescribe fewer antibiotics, then the problem of antibiotic resistance
is controlled," Wald said. "If you can avoid the use of antibiotics, then that
Between 6% and 7% of children who visit doctors seeking care for a
respiratory condition have acute sinusitis, according to the report.
Most cases of acute sinusitis develop from a common cold. Colds usually last
five to seven days and peak within two or three days, Wald said.
Acute sinusitis does not often develop into a life-threatening illness, but
it can be very uncomfortable and even painful. Symptoms of sinusitis include a
runny nose, a persistent daytime cough, headache and fever.
"I think cases of acute sinusitis resolve on their own, by and by," Wald
said. "Children aren't dying left and right from sinusitis. But
there is a quality-of-life issue too. You get better more quickly with
The revised guidelines further underline the need for parents to seek out
paediatricians who are adept at diagnosing and monitoring sinusitis, said Dr
Jordan Josephson, a sinus and allergy specialist at Lenox Hill Hospital in New
York City and author of the book Sinus Relief Now.
This is especially true for children with ongoing sinus problems, he
"Treatment of chronic sinusitis is not simple, and I think it's important
that patients get to a doctor who really understands the disease," Josephson
said. "Guidelines are guidelines. The ultimate thing is to get to a physician
who is a really good diagnostician who can determine whether antibiotics are
The new guidelines for acute sinusitis also discourage the use of imaging
tests to help diagnose the condition in uncomplicated cases.
The US Centers for Disease Control and Prevention has more about antibiotic