A school-age child has had nasal discharge and daytime cough for 12 days without fever. What is the appropriate initial treatment for presumed acute rhinosinusitis?

A school-age child has had nasal discharge and daytime cough for 12 days without fever. What is the appropriate initial treatment for presumed acute rhinosinusitis?

• A. Amoxicillin 80-90 mg/kg/day
• B. Amoxicillin-clavulanate 80-90 mg/kg/day
• C. Saline irrigation for symptomatic relief
• D. Amoxicillin 45 mg/kg/day

Answer: (D)

A school-age child with nasal discharge and daytime cough lasting more than 10 days without fever fits acute bacterial rhinosinusitis, where antibiotics are appropriate after persistent initial symptoms suggest bacterial infection rather than a viral process. The best initial treatment is amoxicillin given at a standard dose of 45 mg/kg per day. This dose effectively covers the common sinus pathogens in otherwise healthy children and is the usual first-line choice when there are no risk factors for resistant organisms. Higher-dose amoxicillin (80–90 mg/kg/day) or amoxicillin–clavulanate is reserved for situations with concerns for resistant bacteria or prior treatment failure, such as recent antibiotic use, daycare exposure, or local high resistance rates. Saline irrigation can help with comfort and nasal hygiene but is not sufficient as the sole treatment when bacterial rhinosinusitis is likely after 12 days of symptoms.

A school-age child with nasal discharge and daytime cough lasting more than 10 days without fever fits acute bacterial rhinosinusitis, where antibiotics are appropriate after persistent initial symptoms suggest bacterial infection rather than a viral process. The best initial treatment is amoxicillin given at a standard dose of 45 mg/kg per day. This dose effectively covers the common sinus pathogens in otherwise healthy children and is the usual first-line choice when there are no risk factors for resistant organisms.

Higher-dose amoxicillin (80–90 mg/kg/day) or amoxicillin–clavulanate is reserved for situations with concerns for resistant bacteria or prior treatment failure, such as recent antibiotic use, daycare exposure, or local high resistance rates. Saline irrigation can help with comfort and nasal hygiene but is not sufficient as the sole treatment when bacterial rhinosinusitis is likely after 12 days of symptoms.