Criteria for evaluation of antimicrobial agents and current therapies for acute sinusitis in children.

Acute sinusitis is a common complication of upper respiratory tract infections in children. The primary causative bacteria are Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Streptococcus pyogenes, and alpha-hemolytic streptococci. Concurrent viral infection may confound interpretation of the clinical response to antimicrobial treatment. First-line antimicrobial treatment is usually with amoxicillin. The increase in frequency of beta-lactamase-producing bacteria in some communities, however, may warrant empirical treatment with other drugs such as amoxicillin/clavulanate, trimethoprim-sulfamethoxazole, cefixime, or cefuroxime. With the marketing of newer antimicrobial drugs for treating sinusitis, it is important for physicians to understand the criteria for evaluating the efficacy of each new drug in relation to existing antimicrobial agents. Criteria for clinical and bacteriologic evaluation of new antimicrobial drugs in the treatment of sinusitis in children are described.