Pediatric emergency medicine trisk 592

e-TABLE 94.3
SIGNS AND SYMPTOMS OF ACUTE BACTERIAL SINUSITIS
Signs/symptoms

Frequency

Nasal discharge
Cough

>90%
75%

Fever
Headache/facial pain
Facial swelling
Periorbital or orbital edema

50%
Rarely seen in young children
10–20% with maxillary sinusitis
20–40% with ethmoid sinusitis

e-TABLE 94.4
CLINICAL CRITERIA FOR THE DIAGNOSIS OF ACUTE
BACTERIAL SINUSITIS IN CHILDREN 1 TO 18 YEARS OF AGE
1. Persistent nasal drainage and/or daytime cough lasting more than 10 days
without improvement or
2. Worsening clinical course (nasal drainage, daytime cough, or fever) after
initial clinical improvement or
3. Purulent nasal drainage for at least 3 consecutive days and fever ≥102.2°F
(39°C)

From Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and
management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013;132(1):e262–e280.


e-TABLE 94.5
TREATMENT OF ACUTE BACTERIAL SINUSITIS
Scenario

Antibiotic

Dose a

Uncomplicated,
Amoxicillin
antibiotic resistance
not suspected

80–90 mg/kg/day (maximum:
2 g/dose)

Moderate to severe
illness, daycare
attendees, children
recently treated
with amoxicillin

Amoxicillinclavulanate

80–90 mg/kg/day of
amoxicillin component

(maximum: 2 g/dose)

Penicillin-allergic
patients

Second- or thirdgeneration
cephalosporin

Cefuroxime 15 mg/kg bid
(maximum: 1 g/day) for
preadolescents; 250 mg bid
for adolescents
Cefdinir 14 mg/kg daily
(maximum: 600 mg/day)
Cefpodoxime 10 mg/kg bid
(maximum: 200 mg/dose)
Cefixime 8 mg/kg/day
(maximum: 400 mg/day)
Clindamycin 10 mg/kg tid
(maximum: 600 mg/dose)

PenicillinCefixime +
anaphylactic
clindamycin
patients <2 yrs of
age with moderate–
severe sinusitis
a The

optimal duration of therapy for sinusitis is unclear. As opposed to selecting a single treatment

duration, some experts recommend continuation of treatment for at least 7 days after patient becomes
asymptomatic.


e-TABLE 94.6
MOST COMMON CAUSES OF CERVICAL LYMPHADENITIS OR
LYMPHADENOPATHY


Site

Region(s)
drained by that
node

Etiologies

Cervical

Head/neck

Viral upper respiratory tract
infections
Pyogenic infections of head/neck

Occipital

Posterior neck
and scalp

Preauricular

Conjunctivae,
eyelids

Submaxillary,
submental

Oral cavity, lips

Supraclavicular

Intrathoracic,
abdomen,
arms, thyroid

Actinomycosis
Cat scratch a
CMV, EBV
Kawasaki disease
Nocardia
Nontuberculous mycobacteria a
Toxoplasmosis
Tuberculosis a
Tularemia
Rubella
Seborrheic dermatitis
Tinea capitis
Viral conjunctivitis (including
adenovirus)

Parinaud oculoglandular syndrome
Cat scratch disease a
Chlamydia trachomatis
Tularemia
Dental caries or abscesses
Herpangina
Herpetic gingivostomatitis
Tuberculosis a