Current issues in the management of acute bacterial sinusitis in children

OBJECTIVE: To review and summarize recent challenges in the microbiology and treatment of acute bacterial sinusitis (ABS), one of the most common infectious diseases in the pediatric community. METHODS: A review of recent medical literature from 1990 to 2006 was acquired using the National Library of Medicine's PUBMED database. RESULTS: Multiple mechanisms of penicillin resistance have been identified: porin channel blockage, beta-lactamase production, and changes in penicillin-binding proteins (PBPs). Other factors affecting treatment efficacy include the role of normal nasopharyngeal flora, such as alpha-streptococci. The more widely documented shift in the causative pathogens of acute otitis media (AOM) following the release of the heptavalent pneumococcal conjugate vaccine (PCV7) has also been documented in two studies of ABS in children. CONCLUSIONS: Treatment of ABS in children is complicated by a number of emerging changes in pathogen resistance patterns. These include beta-lactamase-negative ampicillin resistance (BLNAR) and multi-drug resistance, bacterial interference, and geographic data. These phenomena are likely to impact the treatment of URIs. Appropriate diagnosis and differentiation from viral sinusitis is essential prior to initiating therapy. Clinician education about these emerging issues remains an important strategy in diagnosing and treating ABS in children. This includes an understanding of known patient adherence to antibiotic therapy, such as taste, tolerability, dosing schedule, therapy duration, and patient preference. Clinicians should review judicious ABS treatment approaches that employ agents with documented efficacy against implicated pathogens.