Leung Alexander Kc, Hon Kam Lun, Chu Winnie Cw
Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.
Drugs Context. 2020 Nov 23;9. doi: 10.7573/dic.2020-9-3. eCollection 2020.
In the pediatric age group, approximately 7.5% of upper respiratory tract infections (URIs) are complicated by acute bacterial sinusitis (ABS). Despite its prevalence, ABS is often overlooked in young children. The diagnosis and management present unique challenges in primary care. This is an updated narrative review on the evaluation, diagnosis, and management of ABS.
A PubMed search was performed using the key term 'acute sinusitis'. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English literature and children.
(non-typeable), , and are the major pathogens in uncomplicated ABS in otherwise healthy children. In complicated ABS, polymicrobial infections are common. The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms.
Data from high-quality studies on the management of ABS are limited. The present consensus is that amoxicillin-clavulanate, at a standard dose of 45 mg/kg/day orally, is the drug of choice for most cases of uncomplicated ABS in children in whom antibacterial resistance is not suspected. Alternatively, oral amoxicillin 90 mg/kg/day can be administered. For those with severe ABS or uncomplicated acute sinusitis who are at risk for severe disease or antibiotic resistance, oral high-dose amoxicillin-clavulanate (90 mg/kg/day) is the drug of choice.
在儿童年龄组中，约7.5%的上呼吸道感染（URI）会并发急性细菌性鼻窦炎（ABS）。尽管其发病率较高，但ABS在幼儿中常被忽视。其诊断和管理在初级保健中存在独特挑战。这是一篇关于ABS评估、诊断和管理的更新叙述性综述。
使用关键词“急性鼻窦炎”在PubMed上进行检索。检索策略包括临床试验、荟萃分析、随机对照试验、观察性研究和综述。检索限于英文文献和儿童。
（不可分型）、 和 是健康儿童非复杂性ABS的主要病原体。在复杂性ABS中，混合感染很常见。急性鼻窦炎的诊断主要基于临床且依据严格标准，包括URI持续症状和体征超过10天且无明显改善；起病时有高热和脓性鼻分泌物的URI持续至少3天；以及双相或症状加重。
关于ABS管理的高质量研究数据有限。目前的共识是，对于大多数未怀疑有抗菌药物耐药性的儿童非复杂性ABS病例，标准剂量为45mg/kg/天口服的阿莫西林 - 克拉维酸是首选药物。或者，可给予口服阿莫西林90mg/kg/天。对于患有严重ABS或有严重疾病或抗生素耐药风险的非复杂性急性鼻窦炎患者，口服高剂量阿莫西林 - 克拉维酸（90mg/kg/天）是首选药物。
