CONCLUSION
ABS in children is diagnosed clinically by following a strict set of clinical criteria. Patients commonly present with one of three types of symptoms: persistent URI; severe purulent nasal discharge and fever for at least three consecutive days; or a double sickening. Physical examination findings vary and will not differentiate viral URI symptoms from a diagnosis of ABS. Imaging is not recommended for diagnosis but may be helpful if an orbital or intracranial complication of ABS is suspected.
S pneumoniae, H influenzae, and M catarrhalis continue to be the most common pathogens associated with ABS. However, since the introduction of the 7-valent pneumococcal vaccine, prevalence of H influenzae and β-lactamase–positive H influenzae has increased.
Treatment recommendations vary, based on suspected causative pathogens and presenting symptoms. Amoxicillin or amoxicillin-clavulanate is recommended as firstline antimicrobial treatment for ABS, with alternate antibiotic choices for patients with worsening symptoms or lack of improvement within 72 hours. An awareness of the community’s susceptibility patterns is essential for the clinician who cares for children at risk for ABS.
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