Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Upper respiratory infection symptoms are present 10 or more days beyond onset, or symptoms worsen within 10 days after an initial period of improvement Symptoms may include nasal congestion, nasal drainage, postnasal drainage, facial pain, headache, and fever Symptoms resolve completely within 30 days +++ General Considerations ++ Almost always preceded by a cold Other predisposing conditions include allergies and trauma Maxillary and ethmoid sinuses are most commonly involved Viral upper respiratory infections may cause sinus mucosal injury and swelling, resulting in sinus outflow obstruction, loss of ciliary activity, and mucous hypersecretion Common causative bacterial pathogens Steptococcus pneumoniae Haemophilus influenzae (nontypeable) Moraxella catarrhalis β-hemolytic streptococci +++ Clinical Findings ++ Onset may be gradual or sudden Nasal drainage, nasal congestion Facial pressure or pain Postnasal drainage Hyposmia or anosmia Fever, cough, fatigue Maxillary dental pain Ear pressure or fullness +++ Diagnosis ++ In complicated or immunocompromised patients, sinus aspiration and culture by an otolaryngologist should be considered for diagnostic purposes and to facilitate culture-directed antibiotic therapy Gram stain or culture of nasal discharge does not necessarily correlate with cultures of sinus aspirates If the patient is hospitalized because of rhinosinusitis-related complications, blood cultures should also be obtained +++ Treatment ++ For children with cold symptoms that are not improving by 10 days, observation for up to 3 more days or antibiotic therapy may be chosen, depending on individual circumstances, such as ability to follow up and treat with antibiotics if needed For children with uncomplicated infection who have worsening or severe symptoms (fever of at least 39°C and purulent nasal drainage for at least 3 consecutive days), antibiotic therapy is recommended First-line antibiotic therapy should be amoxicillin or amoxicillin-clavulanate Cefuroxime, cefpodoxime, and cefdinir are recommended for patients with a non–type I hypersensitivity to penicillin Other agents that may be used, particularly in more severe cases where resistant S pneumoniae and H influenzae are suspected, include clindamycin, linezolid, and quinolone Due to high resistance of S pneumoniae and H influenzae, the use of trimethoprim-sulfamethoxazole and azithromycin is not advised Duration of therapy: 7 days after symptoms have resolved Second-line therapies Should be initiated when there is no improvement after 48–72 hours of antibiotic therapy If the patient is already taking amoxicillin–clavulanate or a cephalosporin, intravenous antibiotic therapy should be considered For patients who have evidence of invasive infection or CNS complications, Intravenous therapy with nafcillin or clindamycin plus a third-generation cephalosporin such as cefotaxime should be initiated until culture results become available +++ Outcome +++ Complications ++ Complications occur when infection spreads to adjacent structures, such as the eye and the brain Orbital complications are the most common, arising from the ethmoid sinuses Most common complication of frontal sinusitis ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth