Acute Sinusitis

 

Infection of the sinus mucosa with purulent of nasal (rhinitis, allergies, obstruction) or dental.

Can become chronic, especially in older children and adults.

Clinical signs:

– Association of pain and purulent rhinorrhea

Older children and adults:

– Periorbital pain in frontal sinusitis; pain in the face in case of maxillary sinusitis and / or ethmoidal.

– Purulent rhinorrhea the painful side, nasal obstruction and moderate fever.

– On examination:

• painful pressure from the front or face,

• purulent secretion in the middle meatus and inflammatory mucosa.

The causes are Haemophilus 5 years before influenzae and pneumococcus after.

Special form for infants and young children:

– Acute ethmoiditis: high fever, inflammatory edema of the lower eyelid and the bridge of the nose, purulent rhinorrhea.

– Infection spreading risk to the bone, orbit, meninges.

The causes are Haemophilus influenzae, pneumococci and staphylococci.

Treatment:

– Unblocking the nasopharynx by washing with sodium chloride 0.9% or Ringer’s lactate, 4-6 times / day.

– Pain and fever: paracetamol PO (see page 26).

– Antibiotic depending on severity:

amoxicillin PO: 80 mg / kg / day divided in 2 or 3 doses for 7 to 10 days

In case of allergy to penicillin:

erythromycin PO: 30 to 50 mg / kg / day divided in 2 or 3 doses for 7 to 10 days

– Tooth extraction if it is the cause, as antibiotics.

– If ethmoiditis infant, aggressive treatment is necessary:

ceftriaxone IM: 100 mg / kg / day in 2 divided doses for 10 days

or, failing that,

IV ampicillin 200 mg / kg / day in 3 divided to 4 injections until improvement and oral treatment with amoxicillin 100 mg / kg / day in 2 or 3 doses to complete 10 days of treatment

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