A 7-year-old with a 10-day history of green, thick rhinorrhea is diagnosed with sinusitis. Which treatment is most appropriate?

A 7-year-old with a 10-day history of green, thick rhinorrhea is diagnosed with sinusitis. Which treatment is most appropriate?

• A. Amoxicillin and a decongestant
• B. Amoxicillin and an antihistamine
• C. Saline nasal drops and a decongestant
• D. A topical nasal steroid and cefixime

Answer: (A)

Persistent purulent nasal discharge for about 10 days in a child suggests acute bacterial sinusitis, so the focus is on antibiotic therapy. Amoxicillin is the first-line choice because it effectively treats the usual pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) with a good safety profile. A decongestant adds symptomatic relief by helping to open nasal passages, which can improve comfort and breathing during the infection. Adding an antihistamine isn’t ideal here because antihistamines can dry secretions and thicken mucus, potentially hindering drainage and worsening sinusitis. Relying on saline drops and a decongestant alone would treat symptoms but not address a bacterial infection, which is unlikely to resolve without antibiotics. A topical nasal steroid with a different antibiotic like cefixime isn’t standard first-line management for acute bacterial sinusitis in a school-age child. So, starting antibiotic therapy with amoxicillin and adding a decongestant for symptom relief best fits the clinical scenario.

Persistent purulent nasal discharge for about 10 days in a child suggests acute bacterial sinusitis, so the focus is on antibiotic therapy. Amoxicillin is the first-line choice because it effectively treats the usual pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) with a good safety profile. A decongestant adds symptomatic relief by helping to open nasal passages, which can improve comfort and breathing during the infection.

Adding an antihistamine isn’t ideal here because antihistamines can dry secretions and thicken mucus, potentially hindering drainage and worsening sinusitis. Relying on saline drops and a decongestant alone would treat symptoms but not address a bacterial infection, which is unlikely to resolve without antibiotics. A topical nasal steroid with a different antibiotic like cefixime isn’t standard first-line management for acute bacterial sinusitis in a school-age child.

So, starting antibiotic therapy with amoxicillin and adding a decongestant for symptom relief best fits the clinical scenario.