Antibiotics for Use in Pediatric Rhinosinusitis

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Antimicrobial Dose Specifications


40 mg/kg/day divided tid

Streptococus, Haemophilus influenzae, Moraxella catarrhalis; b-lactamase unstable


45 mg/kg/day divided bid

S. pneumoniae, H. influenzae, M. catarrhalis; anaerobes; staphylococcus; b-lactamase stable


40mg/kg/day divided tid

S. pneumoniae (side effects include serum sicknesslike reaction)


30 mg/kg/day divided bid

S. pneumoniae, H. influenzae, M. catarrhalis (Staphy-lococcus resistant)

CefUroxime axetil

20-30 mg/kg/day divided bid

Staphylococcus; b-lactamase stable


8 mg/kg/day qd or divided bid

Gram-negative organisms; b-lactamase stable (not active vs. Staphylococcus or Pneumococcus)

Cefpodoxime proxetil

10 mg/kg/day divided bid

Staphylococcus, streptococcus, H. influenzae, M. catarrhalis (b-lactamase stability not proven)


15-40 mg/kg/day divided tid

Staphylococcus; anaerobes (poor influenzae coverage)


30 mg/kg/day divided bid

Staphylococcus; anaerobes; b-lactamase stable


15 mg/kg/day divided bid

H. influenzae M. catarrhalis, S. pneumoniae; b-lactamase stable


(50/150) mg/kg/day divided qid

Staphylococcus (side effects include blood dyscrasias and hepatorenal toxicity)


(8/40) mg/kg/day divided bid

S. pneumoniae, H. influenzae, M. catarrhalis; b-lactamase unstable (side effects include blood dyscrasias, anemia, and hepatorenal toxicity)

Modified from Gungor A, Corey J. Pediatric sinusitis: a literature review with emphasis 1997;116:4-15. qd, once a day; bid, twice a day; tid, three times a day; qid, four times

on the role of allergy. Otolaryngol Head Neck Surg a day.

late-phase reaction after exposure to antigen.71 Accordingly, steroid nasal sprays are especially useful in children with allergic rhinitis or nasal polyps or both. Nasal sprays containing ipatropium bromide have a different mechanism of action, and no studies have been done to validate the efficacy of this drug in rhinosinusitis.

Humidification may also be a simple means by which to moisturize sinonasal mucosa, thin nasal secretions, and facilitate mucociliary transport. Care must be taken, however, to minimize potential fungal overgrowth in the humidifier, as this may actually worsen or precipitate rhinosinusitis. Mucolytic agents such as guaifenesin serve to thin mucus, potentially reducing stasis and promoting clearing of secretions. Their efficacy in children has not been established in rhinosinusitis. Antihistamines are inappropriate in chronic rhinosinusitis unless allergy is involved.44

Topical decongestants, typically an a2-agonist such as oxymetazoline, provide rapid symptom relief; nevertheless, they should not be used for longer than 1 week because of their potential to decrease local blood flow,29 exert a ciliotoxic influence,72 and produce a potential rebound congestion.22 Oral decongestants in children are less appropriate, and their role is unclear.50

To summarize, in our practice, medical management consists of the following: at least one 4- to 7-week course of an empirical broad-spectrum b-lactamase-resistant antibiotic, 5 days only of a topical decongestant at initiation of therapy, daily saline nasal irrigations and nasal steroid sprays, antihistamines in patients with positive allergy profiles, room humidification, and judicious use of mucolytics if they afford symptomatic benefit to the patient. In addition, appropriate medical therapy includes evaluation for the multifactorial predisposing factors to rhinosinusitis, with treatment of positive findings. Without proper management of the primary condition initiating sinonasal edema, rhinosinusitis symptoms in children often cannot be controlled, even with aggressive interventions.

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