The majority of acute sinusitis is viral in etiology.
Symptoms usually last 10 days but improve over the course of the illness. Bacterial infections complicate about 5% of viral sinusitis.
These patients typically have symptoms >14 days.
Symptoms may include persistent congestion, rhinorrhea, morning cough and they may have low grade fever and facial pain.
Occasionally children may be more severely ill with high grade fever, headache, and /or severe facial pain. The later presentation is more common with GAS though Streptococcus pneumonia can also be present. Beta-lactam antibiotics are recommended as macrolides (clarithromycin/azithromycin) likely provide inferior coverage for most pathogens.
S. pyogenes (GAS)
Amoxicillin PO TID
7 - 10 days