The Common Cold: Rhinitis Vs. Sinusitis: Physician Information Sheet (Pediatrics)

Careful Antibiotic Use

When parents request antibiotics for rhinitis or the “common cold”... Give them an explanation, not a prescription.

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Rhinitis Versus Sinusitis in Children¹

Remember:

Children have 2-9 viral respiratory illnesses per year.²

In uncomplicated colds, cough and nasal discharge may persist for 14 days or more – long after other symptoms have resolved

Controlled studies do not support antibiotic treatment of mucopurulent rhinitis.⁴

Antibiotics do not effectively treat URI, or prevent subsequent bacterial infections.⁵

Don’t overdiagnose sinusitis

Though most viral URIs involve the paranasal sinuses, only a small minority are complicated by bacterial sinusitis.

Avoid unnecessary treatment by using strict criteria for diagnosis:⁵

Symptoms of rhinorrhea or persistent daytime cough lasting more than 10 - 14 days without improvement.

or

Severe symptoms of acute sinus infection:

• fever (> 39 C) with purulent nasal discharge

• facial pain or tenderness

• periorbital swelling

Treating sinusitis:

• Target likely organisms with first-line drugs:Amoxicillin, Amoxicillin/Clavulanate⁶
• Use shortest effective course:Should see improvement in 2-3 days. Continue treatment for 7 days after symptoms improve or resolve (usually a 10 - 14 day course).⁷
• Consider imaging studies in recurrent or unclear cases:But remember that some sinus involvement is frequent early in the course of uncomplicated viral URI - so interpret studies with caution.

Share the CDC/AAP principles and pamphlets with parents to help them understand when antibiotic treatment risks outweigh the benefits.

• rhinorrhea, fever, and cough are symptoms of viral URI
• changes in mucous to yellow, thick, or green are the natural course of viral URI, NOT an indication for antibiotics.⁸
• treating viral URI will not shorten the course of illness or prevent bacterial infection.⁵

References

1. Rosenstein N, Phillips WR, Gerber MA, Marcy SM, Schwartz B, Dowell SF. The common cold-principles of judicious use. Pediatrics 1998;101:181-184.
2. Monto AS, Ullman BM. Acute respiratory illness in an American community. JAMA 1974;227:164-169.
3. Gwaltney JM, Hendley JO, Simon G, Jordan WS. Rhinovirus infections in an industrial population. JAMA 1967;202:158-164.
4. Todd JK, Todd N, Damato J, Todd WA. Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo-controlled evaluation. Pediatric Inf Dis J 1984;3:226-232.
5. Gadomski AM. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatric Infect Dis J 1993;12:115-120.
6. Avorn J, Solomon D. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann of Intern Med 2000:133:128-135.
7. O’Brien KL, Dowell SF, Schwartz B, et al. Acute sinusitis – prin-ciples of judicious use of antimicrobial agents. Pediatrics 1998;101:174-177.
8. Wald ER. Purulent nasal discharge. Pediatric Infect Dis J 1991;10:329-333.