The American Academy of Pediatrics (AAP) has updated its guidelines for the care of childhood (one to 18 years old) sinusitis and published them in the journal Pediatrics. The previous procedures indicated to automatically prescribe antibiotics and then ensure that infections had cleared up. The new change now intends to prevent the usage of antibiotics in cases where the infection could resolve itself without the usage of antibiotics, reduce imaging such as X-rays, and stop the spread of antibiotic-resistant bacteria.

Doctors are now recommended to state the diagnosis of acute bacterial sinusitis after a child with a upper respiratory infection has worsened or new nasal discharge, daytime cough, or fever after an initial improvement. Medical professionals now have the option to set up a three-day monitoring period, instead of immodestly prescribing antibiotics.

"Limiting antibiotic use in children with persistent acute bacterial sinusitis who may improve on their own reduces common antibiotic-related adverse advents," researchers wrote. The limited use "may also reduce the prevalence of resistant bacterial pathogens."

This change also reverses a long-standing — since 2001 — requirement that doctors obtain x-rays to distinguish between viral and bacterial causes of the sinusitis. Only when there is a suspected central nervous system complication are doctors advised to pursue high-resolution scans, such as computer tomography (CT) scans and MRIs.

"When the paranasal sinuses are imaged, either with plain radiographs, contrast-enhanced CT or MRI in children with uncomplicated URI, the majority of studies will be significantly abnormal with the same kind of findings that are associated with bacterial infection of the sinuses," Ellen R. Wald, M.D. from University of Wisconsin School of Medicine and Public Health, and colleagues wrote. "Accordingly, although normal radiographs or CT or MRI results can ensure that a patient with respiratory symptoms does not have acute bacterial sinusitis, an abnormal image cannot confirm the diagnosis."

Generally, doctors have been encouraged to limit the number of antibiotic prescriptions they are giving to patients because of the increased risk of resistance. Many people do not take their antibiotics for the prescribed time, leading to some bacteria to remain that can develop resistance to the medication. Antibiotics resistance is a looming fear in the medical community, with many infections becoming impervious to last line of defense medications and few new classes of antibiotics in the drug pipeline.

Additionally, the usage of antibiotics is known to perturb the fine balance that exists in the digestive system of humans. Humans have over 2 lbs. of bacteria in their gut, which total to more than 10 trillion bacterial cells, more than 10 times the number of human cells a person has. These bacteria are important in maintaining intestinal health, crowding out harmful bacteria like C. diff, and are known to play a role in autoimmune diseases like ulcerative colitis.

Source: Wald E, Applegate K, Bordley C, et al. Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics. 2013.