- Streptococcus pneumoniae (~30–40%)
- Haemophilus influenzae (~30–35%)
- Moraxella catarrhalis (~10–20%)
First-line therapy
Amoxicillin/clavulanate • p.o. • 45–45 mg/kg/day • 2×/day
Dose is calculated using the amoxicillin component.
Max 1750 mg/day · Duration: 10 days · Continue 7 days after symptom resolution
- • Severe disease
- • Age <2 years
- • Amoxicillin during previous 30 days
- • High local pneumococcal resistance
- • Daycare attendance
- • Immunocompromised patient
Enter weight on Kids to calculate doses
Cefuroxime axetil • p.o. • 30–30 mg/kg/day • 2×/day
Max 1000 mg/day · Duration: 10 days · Continue 7 days after symptom resolution
- • Cefpodoxime: beta-lactam allergy (non-Type I) or intolerance
- • Levofloxacin: selected situations only
- • Beta-lactam failure or unacceptable adverse effects
- • Suspected beta-lactamase–producing organisms
Clinical notes
- • Do not prescribe antibiotics for viral sinusitis.
- • Persistent symptoms >10 days suggest bacterial infection.
- • Severe onset or double worsening supports bacterial sinusitis.
- • Reassess after 48–72 hours if no clinical improvement.
- • AAP Clinical Practice Guideline — Acute Bacterial Sinusitis (2021)
- • IDSA Guideline — Acute Bacterial Rhinosinusitis (2012)
- • ESPID Guideline (2024)
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