Applying Current Evidence Based Practice Guidelines for the Diagnosis and Treatment of Acute Bacterial Sinusitis in Pediatric Patients Using Healthcare Informatics.
This assignment will demonstrate your ability to use healthcare informatics to apply current evidence-based practice guidelines to the management of a pediatric patient diagnosed with acute bacterial sinusitis.
The guidelines that you are to use are in the following article available in the online Purdue Global library.
Hauk, L. (2014). AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age. American Family Physician, 89(8), 676-681.
This assignment has a template that you will use to fill in the requested information.
APA Format. At least three references no older than 5 years.
Please submit to the Dropbox when you have completed your assignment.
| Pediatric Client with Acute Bacterial Sinusitis | ||
List the clinical criteria that must be present to support this diagnosis in pediatric patients from newborn to 21 years of age. Categorize clinical signs and symptoms by: Persistent Symptoms, Severe Onset, or Worsening Symptoms. | List Criteria for Persistent Symptoms. | List Criteria for Severe Onset of Symptoms. | List Criteria for Worsening Symptoms. |
When would imaging studies be indicated? | |||
What is the recommended Antibiotic for Child with No Known Allergies? Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information). | |||
What is the second line Recommended Antibiotic for Child with allergy to PCN Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information). | |||
When is Referral indicated? | |||
What additional medications and or treatment strategies are recommended for treatment or symptomatic control | |||
What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic | |||
When is outpatient 72 hour “observation” acceptable? | |||
What modifications would be needed for the following children: Four year old who is otherwise healthy | |||
Child with immune deficiency | |||
Child with two prior sinus infections | |||
Child with cystic fibrosis | |||
What other conditions would modify these treatment recommendations? | |||
Expert Solution Preview
Introduction: This assignment focuses on the application of healthcare informatics to diagnose and treat acute bacterial sinusitis in pediatric patients. The goal is to evaluate the ability of medical students to use evidence-based practice guidelines to manage this condition in children between the ages of one to eighteen years. Here are the answers to the questions in the content:
1. List the clinical criteria that must be present to support this diagnosis in pediatric patients from newborn to 21 years of age. Categorize clinical signs and symptoms by: Persistent Symptoms, Severe Onset, or Worsening Symptoms.
Clinical criteria that support the diagnosis of acute bacterial sinusitis in pediatric patients include persistent symptoms such as cough, nasal discharge, congestions, facial pain, headache, and fever that last for 10 or more days without improvement. Severe onset criteria include high fever, purulent nasal discharge, and facial pain lasting for 3-4 days. Worsening symptoms include escalating fever, increasing nasal discharge, and new-onset symptoms after a period of improvement.
2. When would imaging studies be indicated?
Imaging studies are not typically required for the diagnosis of acute bacterial sinusitis in pediatric patients. However, they may be considered if there is uncertainty regarding the diagnosis, a suspicion of complications, or the illness is not resolving despite appropriate treatment.
3. What is the recommended Antibiotic for Child with No Known Allergies? Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information).
Amoxicillin-clavulanate is the first-line antibiotic recommended for children with no known allergies. The dose is 45mg/kg/day amoxicillin component in two divided doses every 12 hours for 5-7 days, not to exceed 875mg amoxicillin every 12 hours.
4. What is the second line recommended Antibiotic for Child with allergy to PCN? Provide dose, frequency, mg., ml., length of treatment, number of dosing units (i.e. prescription information).
For children allergic to penicillin, the recommended alternative is clindamycin or linezolid. Clindamycin should be given at a dose of 30-40 mg/kg/day divided into three to four doses for a maximum of 300 mg per dose for ten days.
5. When is Referral indicated?
Referral to an ear, nose, and throat (ENT) specialist is indicated in children who have persistent or recurrent acute bacterial sinusitis or complications of sinusitis like orbital or intracranial abscess.
6. What additional medications and or treatment strategies are recommended for treatment or symptomatic control?
Nasal saline irrigation, nasal decongestants, antihistamines, nasal steroids, and pain control with acetaminophen or ibuprofen is recommended for symptomatic control. Intranasal steroids may be beneficial in children with chronic sinusitis who fail initial therapy.
7. What is the treatment change in a child with worsening symptoms at 72 hours after initiation of antibiotic?
If there is no improvement in symptoms after 72 hours of antibiotic treatment, clinicians should consider changing the first-line antibiotic to amoxicillin-clavulanate with high dose or switch to alternative antibiotics like clindamycin or linezolid.
8. When is outpatient 72 hour “observation” acceptable?
Outpatient observation is acceptable in children older than two years with mild symptoms of acute bacterial sinusitis who have low-grade fever and no signs of severe disease, complications, or comorbidity like immunodeficiency. Parents should be educated to recognize worsening symptoms and be able to contact medical providers if progress is not made.
9. What modifications would be needed for the following children:
– Four-year-old who is otherwise healthy: Lower dosages should be used for drugs, and the liquid formulation of medication should be used instead of pills. Clinicians should also evaluate for medication interactions and adjust doses accordingly.
– Child with immune deficiency: Immunodeficient children are prone to infection by antibiotic-resistant bacteria. Prolonged treatment of 14–21 days may be required, and the choice of antibiotic should target multidrug-resistant bacteria.
– Child with two prior sinus infections: These children could have antibiotic resistance. Therefore, treatment regimens should consider the microbiological evidence of previous infections and response to the previous therapy.
– Child with cystic fibrosis: Children with cystic fibrosis need aggressive therapy and possibly an extended course of antibiotics.
10. What other conditions would modify these treatment recommendations?
Co-morbidities, such as immunodeficiency or respiratory syncytial virus infection, could modify treatment recommendations. Additionally, clinicians need to consider the microbiological evidence of previous infections and response to the previous therapy. Medication allergies and resistance may also modify treatment recommendations.
