A 10-year-old boy had a headache, fever, cough, and nasal discharge for 2 days. His temperature was 38°C (100.4°F). Mucopurulent, yellow nasal discharge, fetid breath, and tenderness over the maxillary area were noted.
A radiograph of the paranasal sinuses demonstrated opacity of the right maxillary sinus and of some of the ethmoid air cells.
Mucosal thickening affected the left maxillary sinus. A culture of the nasal discharge grew Haemophilus influenzae.
Drs Alexander K. C. Leung and Justine H. S. Fong of Calgary, Alberta, comment that Streptococcus pneumoniae, Moraxella catarrhalis, and nontypeable H influenzae are the organisms most often recovered from children with sinusitis. Amoxicillin is a good choice for first-line empiric therapy. In areas where β-lactamase–producing strains of H influenzae and M catarrhalis are common, amoxicillin with potassium clavulanate or a second- or third-generation cephalosporin can be prescribed.
This child was given amoxicillin trihydrate–potassium clavulanate for 10 days; his recovery was uneventful. If untreated, sinusitis may lead to epidural or subdural abscess, cavernous sinus thrombosis, meningitis, cerebral abscess, periorbital or orbital cellulitis, optic neuritis, and osteomyelitis.