Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Publication Date: July 1, 2013
Last Updated: March 14, 2022


Clinicians should make a presumptive diagnosis of acute bacterial sinusitis when a child with an acute URI presents with the following:
  • Persistent illness, ie, nasal discharge (of any quality) or daytime cough or both lasting more than 10 days without improvement; OR
  • Worsening course, ie, worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement; OR
  • Severe onset, ie, concurrent fever (temperature ≥39°C/102.2°F) and purulent nasal discharge for at least 3 consecutive days.
(B, Moderate)

Clinicians should not obtain imaging studies (plain films, contrastenhanced computed tomography [CT], MRI, or ultrasonography) to distinguish acute bacterial sinusitis from viral URI. (BStrong)

Clinicians should obtain a contrast-enhanced CT scan of the paranasal sinuses and/or an MRI with contrast whenever a child is suspected of having orbital or central nervous system complications of acute bacterial sinusitis. (BStrong)

“Severe onset and worsening course” acute bacterial sinusitis.

The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course (signs, symptoms, or both). (BStrong)

Persistent Illness

The clinician should either prescribe antibiotic therapy OR offer additional outpatient observation for 3 days to children with persistent illness (nasal discharge of any quality or cough or both for at least 10 days without evidence of improvement). (BModerate)

Clinicians should prescribe amoxicillin with or without clavulanate as first-line treatment when a decision has been made to initiate antibiotic treatment of acute bacterial sinusitis. (BModerate)

Clinicians should reassess initial management if there is either a caregiver report of worsening (progression of initial signs/ symptoms or appearance of new signs/symptoms) OR failure to improve (lack of reduction in all presenting signs/symptoms) within 72 hours of initial management. (CModerate)

If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve in 72 hours, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic OR initiate antibiotic treatment of the child initially managed with observation. (DWeak)

Recommendation Grading



Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Authoring Organization

Publication Month/Year

July 1, 2013

Last Updated Month/Year

September 13, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Adolescent, Child, Infant

Health Care Settings

Ambulatory, Childcare center, Emergency care, Home health, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management, Treatment


sinusitis, upper respiratory infection (URTI), acute bacterial sinusitis, pediatric acute sinusitis, sinus aspiration, URI

Source Citation

Ellen R. Wald, et al. Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics. 2013; 132(1): e262-e280.


Number of Source Documents
Literature Search Start Date
July 1, 2010
Literature Search End Date
November 1, 2012