Indication | Initial therapy | Second-line therapy* |
Outpatient therapy | ||
Mild/moderate disease¶ | Preferred: Amoxicillin-clavulanate 45 mg/kgΔ per day orally divided in 2 doses (maximum 1.75 g/day) Alternative:◊ Amoxicillin 90 mg/kg per day orally divided in 2 doses (maximum 4 g/day) | Either:
|
Severe disease or risk for antibiotic resistance¶ | Preferred: Amoxicillin-clavulanate 90 mg/kg§ per day orally divided in 2 doses (maximum 4 g/day) | One of the following:
|
Alternatives:◊
| Either:
| |
| Inpatient therapy (see below) | |
Penicillin allergy: Immediate (eg, anaphylaxis) or serious delayed reaction (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) |
| Inpatient therapy (see below) |
Penicillin allergy: Mild delayed reaction |
|
|
Vomiting |
| |
Inpatient therapy | ||
ABRS requiring hospitalization¶ |
|
|
ABRS: acute bacterial rhinosinusitis; IM: intramuscularly; IV: intravenously.
* Second-line therapies are indicated for children who worsen within three days or fail to improve after three days of initial therapy and in whom no pathogen is identified. If a pathogen is identified, antimicrobial therapy should be adjusted according to susceptibilities.
¶ Refer to UpToDate topic on treatment of acute bacterial rhinosinusitis in children for definitions.
Δ Based on amoxicillin component; in the United States, use 200 or 400 mg/5 mL suspension or 200 or 400 mg chewable tablet for appropriate clavulanate ratio.
◊ Alternative regimens may not cover resistant pathogens as well as the suggested initial regimen.
§ Based on amoxicillin component; in the United States, use 600 mg/5 mL suspension or 1000 mg/62.5 mg extended-release tablet for appropriate clavulanate ratio.
¥ Levofloxacin should be reserved for cases in which there is no other safe and effective alternative.
† Individualize vancomycin dose and interval based on serum concentration monitoring, when indicated.
** Metronidazole may be warranted for anaerobic coverage.Do you want to add Medilib to your home screen?