| Guideline | Resources |
| Acute Bacterial Rhinosinusitis Dx/Tx in Children | epocrates Guideline Synthesis |
Key Points
Acute rhinosinusitis (commonly defined ≤4wk) is a clinical dx consisting of s/sx of persistent URI, eg, nasal d/c, nasal obstruction, cough, facial pain/pressure. Abx overuse is major concern. Bacterial dz (ABRS, ~5% of cases) is likely when s/sx not improving ≥10 days, worsening after initial improvement, or severe.
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Peer reviewed & based on multiple guidelines/recommendations from specialty societies/government agencies
Epocrates Guideline Synopsis Last Update:
Oct 14, 2022
Publication Year:
2016
Source:
epocrates
AAP Recommendation Strength
| [R1] | (S) Strong recommendation: Benefits clearly outweigh harms/vice versa (for rec <i>against</i>); excellent quality of evidence |
| [R2] | (R) Recommendation: Benefits outweigh harms/vice versa (for rec <i>against</i>), but quality of evidence not as strong |
| [R3] | (O) Option: Quality of evidence suspect or studies show little advantage of one approach vs another |
| [R4] | (NR) No recommendation: Lack of evidence; balance of benefits and harms is unclear |
AAP Evidence Grades
| [E1] | (A) Well-designed RCTs or diagnostic studies on relevant population |
| [E2] | (B) RCTs or diagnostic studies w/ minor limitations; highly consistent evidence from observational studies |
| [E3] | (C) Observational studies (case-control and cohort design) |
| [E4] | (D) Expert opinion, case reports, reasoning from first principles |
| [E5] | (X) Exceptional situations where validating studies cannot be performed and benefit clearly outweighs harm |
ACR Appropriateness Criteria®
| [R5] | (9) Usually appropriate |
| [R6] | (8) Usually appropriate |
| [R7] | (7) Usually appropriate |
| [R8] | (6) May be appropriate |
| [R9] | (5) May be appropriate |
| [R10] | (4) May be appropriate |
| [R11] | (3) Usually not appropriate |
| [R12] | (2) Usually not appropriate |
| [R13] | (1) Usually not appropriate |
AAI-JTF Recommendation Strength
| [R14] | (S) Strong recommendation: Desirable effects clearly outweigh undesirable effects, or vice versa (for rec <i>against</i>) |
| [R15] | (R) Recommendation: Desirable effects outweigh undesirable effects, or vice versa (for rec <i>against</i>) |
| [R16] | (O) Option: Little clear advantage of 1 approach vs other |
| [R17] | (NR) No recommendation: Unclear balance between benefits/harms AND grade-D evidence |
AAI-JTF Evidence Quality
| [E6] | (A) Meta-analysis of RCTs or >1 RCT |
| [E7] | (B) >1 nonrandomized controlled or quasi-experimental study; or extrapolated from grade-A evidence |
| [E8] | (C) Nonexperimental descriptive studies or extrapolated from B/A evidence |
| [E9] | (D) Expert committee reports, opinions or experience of respected authorities, or extrapolated from A/B/C evidence |
IDSA Recommendation Strength
| [R18] | (S) Strong recommendation: Desireable effects clearly outweigh undesirable effects/vice versa (for rec <i>against</i>) |
| [R19] | (W) Desirable effects closely balanced w/ undesirable effects |
IDSA Evidence Quality
| [E10] | (H) High quality: Consistent, well-performed RCTs or exceptionally strong, unbiased observational studies |
| [E11] | (M) Moderate quality: RCTs w/ limitations or exceptionally strong, unbiased observational studies |
| [E12] | (LM) Low to moderate quality |
| [E13] | (L) Low quality: At least 1 critical outcome from observational studies, RCTs w/ serious flaws, or indirect evidence |
Abbreviations
| AAI-JTF | Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology |
| AAP | American Academy of Pediatrics |
| ABRS | acute bacterial rhinosinusitis |
| ACR | American College of Radiology |
| amox/clav | amoxicillin/clavulanate |
| ant | anterior |
| ARS | acute rhinosinusitis |
| CF | cystic fibrosis |
| clinda | clindamycin |
| CT | computerized tomography |
| cx | culture |
| d/c | discharge |
| diff | differential |
| ENT | otolaryngology (ear, nose, and throat) |
| EOM | extraocular movement |
| GERD | gastroesophageal reflux disease |
| HA | headache |
| ID | infectious disease |
| IDSA | Infectious Diseases Society of America |
| IV | intravenous |
| mod | moderate |
| mono-tx | monotherapy |
| MRI | magnetic resonance imaging |
| PCN | penicillin |
| PNS | penicillin nonsusceptible |
| PO | by mouth |
| post | posterior |
| r/o | rule out |
| RCT | randomized controlled trial |
| resp | respiratory |
| TMP/SMX | trimethoprim/sulfamethoxazole |
| URI | upper respiratory infection |
AAP Recommendation Strength
| R1 | = | (S) Strong recommendation: Benefits clearly outweigh harms/vice versa (for rec <i>against</i>); excellent quality of evidence |
| R2 | = | (R) Recommendation: Benefits outweigh harms/vice versa (for rec <i>against</i>), but quality of evidence not as strong |
| R3 | = | (O) Option: Quality of evidence suspect or studies show little advantage of one approach vs another |
| R4 | = | (NR) No recommendation: Lack of evidence; balance of benefits and harms is unclear |
AAP Evidence Grades
| E1 | = | (A) Well-designed RCTs or diagnostic studies on relevant population |
| E2 | = | (B) RCTs or diagnostic studies w/ minor limitations; highly consistent evidence from observational studies |
| E3 | = | (C) Observational studies (case-control and cohort design) |
| E4 | = | (D) Expert opinion, case reports, reasoning from first principles |
| E5 | = | (X) Exceptional situations where validating studies cannot be performed and benefit clearly outweighs harm |
ACR Appropriateness Criteria®
| R5 | = | (9) Usually appropriate |
| R6 | = | (8) Usually appropriate |
| R7 | = | (7) Usually appropriate |
| R8 | = | (6) May be appropriate |
| R9 | = | (5) May be appropriate |
| R10 | = | (4) May be appropriate |
| R11 | = | (3) Usually not appropriate |
| R12 | = | (2) Usually not appropriate |
| R13 | = | (1) Usually not appropriate |
AAI-JTF Recommendation Strength
| R14 | = | (S) Strong recommendation: Desirable effects clearly outweigh undesirable effects, or vice versa (for rec <i>against</i>) |
| R15 | = | (R) Recommendation: Desirable effects outweigh undesirable effects, or vice versa (for rec <i>against</i>) |
| R16 | = | (O) Option: Little clear advantage of 1 approach vs other |
| R17 | = | (NR) No recommendation: Unclear balance between benefits/harms AND grade-D evidence |
AAI-JTF Evidence Quality
| E6 | = | (A) Meta-analysis of RCTs or >1 RCT |
| E7 | = | (B) >1 nonrandomized controlled or quasi-experimental study; or extrapolated from grade-A evidence |
| E8 | = | (C) Nonexperimental descriptive studies or extrapolated from B/A evidence |
| E9 | = | (D) Expert committee reports, opinions or experience of respected authorities, or extrapolated from A/B/C evidence |
IDSA Recommendation Strength
| R18 | = | (S) Strong recommendation: Desireable effects clearly outweigh undesirable effects/vice versa (for rec <i>against</i>) |
| R19 | = | (W) Desirable effects closely balanced w/ undesirable effects |
IDSA Evidence Quality
| E10 | = | (H) High quality: Consistent, well-performed RCTs or exceptionally strong, unbiased observational studies |
| E11 | = | (M) Moderate quality: RCTs w/ limitations or exceptionally strong, unbiased observational studies |
| E12 | = | (LM) Low to moderate quality |
| E13 | = | (L) Low quality: At least 1 critical outcome from observational studies, RCTs w/ serious flaws, or indirect evidence |