Treatment of sinusitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-SIM-FIMMG)

Abstract

Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses. Bacterial sinusitis usually occurs as a complication of viral infections of the upper respiratory tract and is a frequent cause of medical consultation. The clinical presentation of acute bacterial sinusitis can vary. It most commonly manifests as an upper respiratory tract infection (nasal congestion, postnasal drip, cough) that persists for more than 10 days without clinical improvement. Unfortunately, updated guidelines in paediatric age are not currently available. The purpose of this consensus is to provide guidelines for the therapeutic management of previous healthy paediatric patients with sinusitis. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, combining the terms "children" and "sinusitis" and "antibiotics" and "rhinosinusitis" with a date restriction from 2012 to April 2024, but without language limitations. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. In children with a diagnosis of uncomplicated acute bacterial sinusitis, made according to strict clinical criteria, systemic empiric antibiotic therapy with amoxicillin or amoxicillin-clavulanic acid is indicated at a high dose (90 mg/kg/day, calculated based on amoxicillin, preferably in 3 daily doses) and for at least 10 days. In children with chronic sinusitis, systemic antibiotic treatment is not recommended, and it is not possible to make any specific recommendation regarding antibiotic agents due to the scarcity of scientific evidence supporting treatment. In conclusion, the diagnosis of sinusitis is primarily clinical, and despite acute sinusitis generally having a favourable course, some cases can present orbital and intracranial complications. The misuse of antibiotics in managing upper respiratory tract infections, including acute sinusitis, and the challenges posed by antibiotic resistance are a current issue in paediatric care. Due to the scarcity, heterogeneity, and poor quality of available evidence either supporting or opposing the use of systemic antibiotic therapy in children with sinusitis prospective studies on larger and more homogeneous cohort are needed.

Keywords: Antibiotics; Children; Sinusitis; Treatment.