Applying Current Evidence Based Practice Guidelines for the Diagnosis and Treatment of Acute Bacterial Sinusitis in Pediatric Patients Using Healthcare Informatics.

Pediatric Client with Acute Bacterial Sinusitis

List the clinical criteria that must be present to support this diagnosis in pediatric patients from newborn to 21 years of age. Categorize clinical signs and symptoms by Persistent Symptoms, Severe Onset, or Worsening Symptoms.

List Criteria for Persistent Symptoms.

Persistent symptoms must include; nasal discharge, coughing that has lasted for about 10 days with no sign of improvement.

List Criteria for Severe Onset of Symptoms.

Symptoms at this stage must include; concurrent fever with temperature ≥39°C and oozing nasal discharge for about 3 consecutive days.

List Criteria for Worsening Symptoms.

Worsening symptoms must include; worsening or new onset of nasal discharge, daytime coughs, or fever after initial improvement.

 When would imaging studies be indicated?

Clinicians are encouraged not to take imaging studies because imaging is not useful in the diagnosis. The only time imaging can be studied is when a child is suspected to have orbital or complications in the central nervous system. In such a case, a contrast-enhanced computed tomography scan of the paranasal sinuses can be taken.

What is the recommended Antibiotic for Child with No Known Allergies?

Provide dose, frequency, mg.ml. length of treatment, number of dosing units (i.e. prescription information).

 Only recommendations for allergic patients have been provided. A child with no known allergies may therefore, be treated using amoxicillin or antibiotic therapy.

What is the second line Recommended Antibiotic for Child with allergy to PCN

Provide dose, frequency, mg., ml. length of treatment, number of dosing units (i.e. prescription information).

Clinicians are encouraged to use cefdinir, cefuroxime, or cefpodoxime to treat patients who are allergic to amoxicillin with a non–type 1. These drugs can also be used to treat patients with a serious type 1 immediate. The clinicians are also recommended to use a combination of clindamycin and cefixime to treat children aged below 2 years who have a serious type 1 hypersensitivity to penicillin and moderate or more severe sinusitis.

What additional medications and or treatment strategies are recommended for treatment or symptomatic control

 Antibiotic therapy or continuous observations are also recommended treatments.

What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic

 The treatment change is provided under Key Action 5B of the guideline. This guideline requires the clinician to change the antibiotic therapy if the initial diagnosis failed to improve after 72 hours and the child was being managed by antibiotics or observation. The guideline ensures that the children are provided with optimal antimicrobial treatment to avoid further complications and reduce symptoms severity.

When the child had been initially treated with amoxicillin, the clinician should initiate high-dose amoxicillin- amoxicillin. If there is no further change, Clindamycina andcefixime or linezolid and cefixime or levofloxacin should be given to the child (Ellen et al., 2013).

When is outpatient 72 hour “observation” acceptable?

When the caregiver was not able to identify changes in symptoms from the previous prescribed drugs.

What modifications would be needed for the following children:

Four year old who is otherwise healthy

In case the child does not show any sign of complication and looks healthy, amoxicillin can be initiated. Amoxicillin is normally recommended because it is affordable, easy to be administered, and there is no more concern about complications resulting from its use.

Child with immune deficiency

 Limiting antibiotics

Child with two prior sinus infections

 They can be managed with antibiotic therapy

Child with cystic fibrosis

 Physical continuous observation

What other conditions would modify these treatment recommendations?

 The recommendations of the above doses can be changed due to some factors such as Severity of the symptoms, quality of life of the child, the antibiotics used recently, and outcomes with acute bacterial sinusitis, the price of antibiotics, the potential adverse effect of the drugs, and persistence of respiratory symptoms (Garbutt et al., 2004).