Öz

Objectives: Acute bacterial sinusitis (ABS) is among frequent infections in children. Its diagnosis is clinical unless a suspicion of complication exists. This study aimed to evaluate pediatricians’ clinical approaches to ABS.

Materials and Methods: This retrospective study analyzed diagnosis, treatment and complication data of patients diagnosed with ABS between June 2015 and June 2018 in our pediatric primary care unit.

Results: The study group consisted of 536 patients [female/male 235/301 (43.8%/56.2%)]. The median age was 6.6 (7 months-17.9 years) years. Median duration of symptoms was 7 (1-46) days. Major complaints were cough (n=379, 70.7%), nasal discharge (n=234, 43.7%) and fever (n=168, 31.3%). Among 468 patients with available data, persistent (>10 days) upper respiratory tract infection (URTI) was present in 198 (42.3%) while 8 (1.7%) had severe URTI. Worsening URTI data could not be defined because of inadequate records. Duration of symptoms was <3 days in 26 (16.2%) patients. Physical examination revealed postnasal discharge (n=393, 73.3%), frontal pain (n=26, 4.9%) and sinus tenderness when pressure was applied (n=25, 4.7%). Water’s paranasal sinus radiograph was performed in 38 (7.1%) patients. Most preferred antibiotics were amoxicillinclavulanate 167 (78.4%), clarithromycin 18 (8.5%) and cefdinir 13 (6.1%). Symptomatic treatment was rarely prescribed [nasal decongestant (n=38, 17.8%), systemic antihistamines (n=23, 10.8%]. The median treatment period was 10 (3-30) days. Five patients (0.9%) were hospitalized for complications [preseptal cellulitis (n=4), frontal bone osteomyelitis and subdural abscess secondary to facial cellulitis (n=1)]. Patients with preseptal cellulitis were treated with parenteral ampicillin-sulbactam and the patient with osteomyelitis and abscess received ceftriaxone, vancomycin and metronidazole treatment following abscess drainage.

Conclusion: Our results indicate that the diagnosis was substantially based on clinical evaluation even though complete compliance to clinical definitions recommended by current guidelines was lacking, and antibiotic treatment plans were often correct. Moreover, although rare, performance of further investigations and/or prescription of symptomatic treatment were observed. It was aimed to emphasize that clinicians should be encouraged for complete patient records and compliance to current guidelines.