The role of antibiotics in pediatric chronic rhinosinusitis

OBJECTIVES Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology. DATA SOURCE Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis. RESULTS Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta-lactamase producing aerobic and anaerobic organisms, amoxicillin-clavulanate is the first-line regimen for most patients. Clindamycin is adequate for penicillin-allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy. CONCLUSIONS Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. LEVEL OF EVIDENCE 7.