A 9-year-old child is brought to the clinic with facial pain, purulent nasal discharge, and tenderness over the maxillary sinus for the past 4 days. After completing the physical examination, the PNP should:

A 9-year-old child is brought to the clinic with facial pain, purulent nasal discharge, and tenderness over the maxillary sinus for the past 4 days. After completing the physical examination, the PNP should:

• A. Order radiologic studies
• B. Treat the condition empirically with amoxicillin
• C. Order culture and sensitivity tests of the nasal discharge
• D. Treat the condition with sinus irrigation

Answer: (B)

When a child shows signs consistent with acute bacterial sinusitis (facial pain over a sinus, purulent nasal discharge) and the symptoms have been present for several days with notable severity, the appropriate first step is to start empiric antibiotic therapy rather than pursuing imaging or cultures. Amoxicillin is the first-line choice because it effectively covers the common pathogens—Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis—and avoids unnecessary radiation from radiographs. Imaging is not routinely needed in otherwise healthy children with typical clinical features, and nasal discharge cultures are not helpful for guiding initial treatment in uncomplicated cases. Antibiotics should be given, and if there’s no improvement within about 48–72 hours, or if the child has risk factors for resistant organisms, then consider escalation (such as amoxicillin-clavulanate) or further evaluation. Supportive measures like saline nasal irrigation can be used as adjuncts, but they don’t replace antibiotics.

When a child shows signs consistent with acute bacterial sinusitis (facial pain over a sinus, purulent nasal discharge) and the symptoms have been present for several days with notable severity, the appropriate first step is to start empiric antibiotic therapy rather than pursuing imaging or cultures. Amoxicillin is the first-line choice because it effectively covers the common pathogens—Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis—and avoids unnecessary radiation from radiographs. Imaging is not routinely needed in otherwise healthy children with typical clinical features, and nasal discharge cultures are not helpful for guiding initial treatment in uncomplicated cases. Antibiotics should be given, and if there’s no improvement within about 48–72 hours, or if the child has risk factors for resistant organisms, then consider escalation (such as amoxicillin-clavulanate) or further evaluation. Supportive measures like saline nasal irrigation can be used as adjuncts, but they don’t replace antibiotics.