After 14 days of amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child has mucopurulent nasal discharge with eyelid induration and erythema. What is the next course of action?

After 14 days of amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child has mucopurulent nasal discharge with eyelid induration and erythema. What is the next course of action?

• A. Amoxicillin 80 mg/kg/day for 14 days
• B. Amoxicillin-clavulanate for 10 to 14 days
• C. Antibiotic ophthalmic drops for 5 to 7 days
• D. Referral to a pediatric otolaryngologist

Answer: (D)

When a child with acute bacterial rhinosinusitis does not improve after a full course of appropriate antibiotics and shows signs suggesting a complication, the next step is specialist evaluation. In this scenario, after 14 days of amoxicillin at a high dose, mucopurulent discharge plus eyelid induration and erythema raise concern for an orbital or periorbital process rather than simple sinusitis. That combination signals potential spread beyond the sinuses and the risk of serious complications, so it’s important to involve a pediatric otolaryngologist who can assess the sinuses more precisely, obtain imaging if needed, and decide on further management which may include IV antibiotics or surgery. An ophthalmic antibiotic drop wouldn’t address the sinus infection or possible orbital involvement. Simply increasing the antibiotic dose or switching to a different oral agent could be warranted in some scenarios, but the presence of periorbital findings after an extended course makes timely ENT input the most appropriate next step to prevent progression and to plan definitive treatment if needed. Referral to pediatric ENT ensures a comprehensive evaluation of sinus disease, potential obstruction, and the possibility of surgical intervention if indicated.

When a child with acute bacterial rhinosinusitis does not improve after a full course of appropriate antibiotics and shows signs suggesting a complication, the next step is specialist evaluation. In this scenario, after 14 days of amoxicillin at a high dose, mucopurulent discharge plus eyelid induration and erythema raise concern for an orbital or periorbital process rather than simple sinusitis. That combination signals potential spread beyond the sinuses and the risk of serious complications, so it’s important to involve a pediatric otolaryngologist who can assess the sinuses more precisely, obtain imaging if needed, and decide on further management which may include IV antibiotics or surgery.

An ophthalmic antibiotic drop wouldn’t address the sinus infection or possible orbital involvement. Simply increasing the antibiotic dose or switching to a different oral agent could be warranted in some scenarios, but the presence of periorbital findings after an extended course makes timely ENT input the most appropriate next step to prevent progression and to plan definitive treatment if needed. Referral to pediatric ENT ensures a comprehensive evaluation of sinus disease, potential obstruction, and the possibility of surgical intervention if indicated.