Acute Sinusitis

1. DDx:

    1. Bacterial: >10 days last, >39 C fever, Relapse after temporary healing

    2. Viral

2. Imaging

    1. Water X-ray

    2. Coronal PNS CT scan without contrast

3. Treatment for children

    1. Syrup amoxicillin 250mg/4cc #1 2*w/3 cc tds (90mg/kg/day)

        1. or cap amoxicillin 500 mg tds #28

        2. or Tab co-amoxiclav 625mg tds #28 (45mg/kg/day)

        3. or syrup farmentin 643 w/3 bid #1

    2. Susp acetaminophen 120mg/5cc #1 qid w/2cc (10mg/kg)

        1. or tab acetaminophen 325mg qid #30

    3. Nasal drop NaCl 0.65% #1

        1. or serum N/S for irrigation

    4. Nasal drop pseudoephedrine #1 2drops for 3-5days

        1. do not prescribe for bacterial forms

    5. Elixir diphenhydramine tds #1

4. Ab therapy for adults

    1. cap amoxicillin 1gr q8h

        1. or tab co-amoxiclav 625 tds

    2. for hypersensitivity

        1. tab azithromycin 250 mg