International Journal of Pediatric Otorhinolaryngology
Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess
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.
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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.
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