Acute bacterial sinusitis in children: an updated review

Article Details

Alexander KC Leung MBBS, FRCPC, FRCP (UK and Irel), FRCPCH, FAAP, Kam Lun Hon MD, FAAP, FCCM, Winnie CW Chu MD, FRCR

Article Type


Related Articles

Article Page


Background: In the pediatric age group, approximately 7.5% of upper respiratory tract infections (URIs) are complicated by acute bacterial sinusitis (ABS). Despite its prevalence, ABS is often overlooked in young children. The diagnosis and management present unique challenges in primary care. This is an updated narrative review on the evaluation, diagnosis, and management of ABS.

Methods: A PubMed search was performed using the key term ‘acute sinusitis’. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English literature and children.

Results: Haemophilus influenzae (non-typeable), Streptococcus pneumoniae, and Moraxella catarrhalis are the major pathogens in uncomplicated ABS in otherwise healthy children. In complicated ABS, polymicrobial infections are common. The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms.

Conclusion: Data from high-quality studies on the management of ABS are limited. The present consensus is that amoxicillin-clavulanate, at a standard dose of 45 mg/kg/day orally, is the drug of choice for most cases of uncomplicated ABS in children in whom antibacterial resistance is not suspected. Alternatively, oral amoxicillin 90 mg/kg/day can be administered. For those with severe ABS or uncomplicated acute sinusitis who are at risk for severe disease or antibiotic resistance, oral high-dose amoxicillin-clavulanate (90 mg/kg/day) is the drug of choice.

Keywords: amoxicillin, amoxicillin-clavulanate, bacterial sinusitis, mucociliary dysfunction, sinus ostial obstruction.

Citation: Leung AKC, Hon KL, Chu WCW. Acute bacterial sinusitis in children: an updated review. Drugs in Context 2020; 9: 2020-9-3. DOI: 10.7573/dic.2020-9-3

Contributions: Alexander KC Leung is the principal author. Kam Lun Hon and Winnie CW Chu are co-authors who contributed and helped with the drafting of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Alexander KC Leung and Kam Lun Hon are associate editors of Drugs in Context and confirm that this article has no other conflicts of interest. This manuscript was sent out for independent peer review by the Managing Editor. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: None

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2020 Leung AKC, Hon KL, Chu WCW. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Leung AKC, Hon KL, Chu WCW. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL:

Correspondence: Alexander KC Leung, The University of Calgary, The Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5.

Provenance: Invited; externally peer reviewed.

Submitted: 17 September 2020; Peer review comments to author: 28 October 2020; Revised manuscript received: 29 October 2020; Accepted: 29 October 2020; Publication date: 23 November 2020.

Drugs in Context is published by BioExcel Publishing Ltd. Registered office: Plaza Building, Lee High Road, London, England, SE13 5PT.

BioExcel Publishing Limited is registered in England Number 10038393. VAT GB 252 7720 07.

For all manuscript and submissions enquiries, contact the Editorial office

For all permissions, rights and reprints, contact David Hughes

Download free full text PDF