Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess

https://doi.org/10.1016/j.ijporl.2007.02.013Get rights and content

Summary

Objective

To determine the pattern of pre-hospitalization antibiotic use in children developing a subperiosteal orbital abscess (SPA) as a complication of acute sinusitis.

Study design and setting

Ten-year retrospective chart review in a tertiary pediatric center of children under the age of 18 years requiring operative drainage of a SPA as a complication of acute sinusitis.

Results

There were 39 children (M 25; F 14). Ten children (26%) received antibiotic therapy prior to admission, for a median duration of 1.6 days. On presentation, 72% had rhinorrhea and/or fever, for average durations of 3.9 and 2.5 days, respectively. Streptococcal species sensitive to penicillin were grown from 51% of SPA cultures.

Conclusion

Although few children in this series received antibiotics prior to their presentation with a SPA, prodromal sinusitis symptoms were of too short a duration to warrant institution of antibiotic therapy based on the American Academy of Pediatrics guidelines for acute sinusitis.

Significance

SPA may not be a preventable complication of acute sinusitis in children.

Introduction

Subperiosteal orbital abscess (SPA) is an uncommon complication of acute sinus infection in children. Guidelines by the American Academy of Pediatrics (AAP) published in 2001 [1] for management of acute sinusitis in children focus primarily on promoting a more rapid clinical cure, thereby minimizing morbidity. Although it may be inferred that early medical treatment of acute sinusitis in children will also minimize development of related complications, this remains uncertain. We therefore undertook a retrospective study to evaluate our experience with SPA secondary to acute sinusitis in children and the relationship to prior antibiotic use.

Section snippets

Study design and setting

A 10-year retrospective analysis was conducted on children under 18 years of age admitted to the Royal Children's Hospital, Melbourne, Australia with acute sinusitis complicated by SPA requiring surgical drainage between January 1996 and December 2005. All children had pre-operative computerized tomography (CT) scans that showed SPA in association with paranasal sinus opacification. Patients admitted with orbital complications of acute sinusitis treated by medical therapy alone were not

Results

We identified 50 children admitted with a SPA requiring surgical drainage. Eleven were excluded from final analysis due to SPA development as a consequence of trauma (2), and the presence of cystic fibrosis (2), diabetes mellitus (1), and long-term dexamethasone therapy (1). Five files were unavailable for analysis. There were 39 remaining patients (25 M:14 F), average age 7.8 years (0.1–17). Co-morbidities included 14 children with atopy (asthma (9); eczema/hayfever (5)), and one with

Discussion

In this study, only 26% of children received oral antibiotic treatment prior to their presentation with a SPA requiring surgical drainage, for an average duration of 1.6 days. This suggests SPA complicating acute sinusitis in children develops when antibiotics are withheld or commenced too late in the course of their illness, and raises the possibility that development of SPA may be prevented by earlier use of antibiotics.

The AAP [1] guidelines on uncomplicated acute bacterial sinusitis state

Acknowledgement

Work by the senior author is supported by the Bertalli Otolaryngology Research Centre, Murdoch Children's Research Institute.

References (8)

  • P. Fireman

    Diagnosis of sinusitis in children: emphasis on the history and physical examination

    J. Allergy Clin. Immunol.

    (1992)
  • American Academy of Pediatrics

    Clinical practice guidelines: management of sinusitis

    Pediatrics

    (2001)
  • R. Rahbar et al.

    Management of orbital subperiosteal abscess in children

    Arch. Otolaryngol. Head Neck Surg.

    (2001)
  • I. Brook et al.

    Medical management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on paediatric and adult sinusitis

    Ann. Otol. Rhinol. Laryngol.

    (2000)
There are more references available in the full text version of this article.

Cited by (25)

  • Pediatric subperiosteal orbital abscess characterization and prediction of size, location, and management

    2021, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    In a smaller cohort of 39 patients, Sinclair and Berkowitz found only 26% of pediatric patients received antibiotic therapy before admission [17]. They concluded that antibiotic therapy was not warranted when sinusitis was presented for a short duration and SPOA may be unavoidable [17]. Interestingly, none of the patients were conservatively managed with saline spray or oxymetazoline prior to diagnosis.

  • Urgent Infections of the Head and Neck

    2018, Medical Clinics of North America
    Citation Excerpt :

    Subperiosteal orbital abscess (SPOA) Orbital complications of sinusitis typically develop early in the clinical course and are generally thought not to be preventable.26 Preseptal cellulitis presents with edema and erythema of the upper and lower eyelids that accompanies signs and symptoms of acute sinusitis.

  • Management of pediatric orbital cellulitis: A systematic review

    2018, International Journal of Pediatric Otorhinolaryngology
  • Microbiology and antibiotic therapy of subperiosteal orbital abscess in children with acute ethmoiditis

    2018, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    Our study is part of the largest studies in the literature that specifically focused on the bacteriology of operated subperiosteal abscess in children. In Table 1, we compared our results with microbiological culture results of SPOA in other studies [1,14,20–25]. In our study, we found three main bacteria: Streptococcus (60%), Staphylococus aureus (12%) and anaerobic bacteria (12%).

View all citing articles on Scopus
View full text