Acute Bacterial Sinusitis Diagnosis and Treatment Research Paper

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	Pediatric Client with Acute Bacterial Sinusitis (ABS)
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.	Persistent Symptoms: Nasal discharge (any type thereof); Cough (of any type); Symptoms occurring for 10 days or more; No improvement is registered.	Severe Onset of Symptoms: Fever (≥39°C/102.2°F); Purulent nasal discharge; Symptoms occurring for 3 days or more; Possible worsening of the symptoms.	Worsening Symptoms: Nasal discharge continued or intensified; Cough during the day; Consistent fever; A previous improvement could be observed (Agency for Healthcare Research and Quality, 2013).
When would imaging studies be indicated?	Imaging studies are not recommended to distinguish between ABS and viral Upper Respiratory Infection (URI) (Agency for Healthcare Quality and Management, 2016). Instead, MRI is advised when a child has complications related to the orbital or central nervous system (Agency for Healthcare Research and Quality, 2013).
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).	Penicillin (PCN) is typically prescribed as the medication for managing an instance of ABS in children (Agency for Healthcare Quality and Management, 2016). Additionally, Amoxicillin (Trimox, Biomox) and Amoxicillin-clavulanate (Augmentin) can be prescribed to address ABS in children without allergies. Amoxicillin 500 mg PO TID should be viewed as an appropriate dosage for children without allergies (DeMuri & Wald, 2013).
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).	Before providing a child with a medication against ABS, one must consider allergy testing to detect if the patient is allergic to any substances. In case an allergy is identified during radioallergosorbent tests, second- or third-generation Cephalosporin is recommended, as well as Macrolide or Clindamycin. Clindamycin 30–40 mg/kg/day PO TID is recommended in the identified scenario (Agency for Healthcare Quality and Management, 2016).
When is Referral indicated?	In case the suggested treatment strategy has not produced any effect over three weeks, a referral to an otolaryngologist is strongly recommended. The reasons for a referral in the identified case include the necessity to determine the obstacles that inhibit the treatment process. Otherwise, a patient will be exposed to a range of external threats including a possible development of a comorbid issue such as nasal eosinophilia (Ragab et al., 2015).
What additional medications and or treatment strategies are recommended for treatment or symptomatic control	It is crucial to make sure that patients’ contact data is stored in the database so that they could be contacted after the treatment process is over. Nurse assessments should be conducted over the phone so that the patient’s health status could be defined, and the existing threats could be managed successfully (Agency for Healthcare Quality and Management, 2016).
What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic	In case symptoms are not managed within 72 hours, it is imperative to carry out a reevaluation of the child. Particularly, the assessment will have to be taken so that “peritonsillar cellulitis or abscess, infectious mononucleosis” (Agency for Healthcare Quality and Management, 2016, para. 21) could be excluded. Furthermore, the possibility of being infected with Fusobacterium necrophorumneeds to be addressed (Agency for Healthcare Quality and Management, 2016).
When is outpatient 72 hour “observation” acceptable?	In case an outpatient’s state worsens within 3 days, and the patient does not contact the healthcare services, a reevaluation is due (Agency for Healthcare Quality and Management, 2016). Creating the environment in which patients’ well-being is secured, the staff of a healthcare facility must ensure that outpatients’ needs are managed as efficiently as those of inpatients. Therefore, monitoring the changes in the health status of outpatients is crucial (Okubo et al., 2017).
What modifications would be needed for the following children: Four year old who is otherwise healthy	It should be borne in mind that children with special needs require extra attention. For instance, very young children demand extensive support. A four-year-old child will require a careful identification of the amount of medication that can be administered. Per each kg of the child’s weight, 6.4 mg of Amoxicillin–Clavulanate will be required (DeMuri & Wald, 2013).
Child with immune deficiency	CT or MRI along with a physical examination allowing for a precise identification of the existing threats will have to be carried out so that the possibility of worsening could be reduced. Amoxicillin, either alone, or combined with Clavulanate, will have to be used to reduce the chances of the child developing complications (e.g., fever). Furthermore, it may be necessary to administer “Clindamycin and cefixime OR linezolid and cefixime OR levofloxacin” (Agency for Healthcare Research and Quality, 2013, para. 3).
Child with two prior sinus infections	In case a child has already experienced ABS, it will be necessary to consider placing them under a longer therapy. Thus, possible issues regarding the development of resistance toward the medicine will be addressed successfully (Santee et al., 2016). In case the suggested medical treatment turns out to be inefficient due to prior instances of ABS, an increase in the dosage or a change of the medication may be offered.
Child with cystic fibrosis	Because of the obstacles that fibrosis creates for clearing the fluid and debris developing due to ABS, the process of managing the patients’ needs will include preventing the thickening of secretions so that the recovery process could occur at a faster pace. The issues associated with the management of cystic fibrosis will also be addressed accordingly, which will lead to quick recovery and a rapid improvement in patients’ health status.
What other conditions would modify these treatment recommendations?	The identified suggestions for managing ABS may be altered by primary ciliary dyskinesia and anatomic abnormalities of the sinuses, according to the Agency for Healthcare Quality and Management (2016). The presence of the specified issues is likely to entail the need to reconsider the dosage of prescribed medications and the treatment strategies suggested by the therapist. As a result, the aggravation of the conditions listed above will be avoided successfully.

References

Agency for Healthcare Research and Quality. (2013). Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Web.

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Agency for Healthcare Quality and Management. (2016). Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Web.

DeMuri, G., & Wald, E. R. (2013). Acute rhinosinusitis treatment. JAMA, 307(22), 429-437. Web.

Okubo, K., Kurono, Y., Ichimura, K., Enomoto, T., Okamoto, Y., Kawauchi, H., … Masuyama, K. (2017). Japanese guidelines for allergic rhinitis 2017. Allergology International, 66(2), 205-219. Web.

Ragab, A., Farahat, T., Al-Hendawy, G., Samaka, R., Ragab, S., & El-Ghobashy, A. (2015). Nasal saline irrigation with or without systemic antibiotics in treatment of children with acute rhinosinusitis. International Journal of Pediatric Otorhinolaryngology, 79(12), 2178-2186. Web.

Santee, C. A., Nagalingam, N. A., Faruqi, A. A., Demuri, G. P., Gern, J. E., Wald, E. R., & Lynch, S. V. (2016). Nasopharyngeal microbiota composition of children is related to the frequency of upper respiratory infection and acute sinusitis. Microbiome, 4(1), 34-42. Web.

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Reading time	4 min
Type	Research Paper
Pages	3
Words	1026
Subjects	Health & Medicine Diagnostics
Language	🇺🇸 English