Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess

Objective: To determine the pattern of pre-hospitalization antibiotic use in children developing a subperiosteal orbital abscess (SPA) as a complication of acute sinusitis. Study design and setting: Ten-year retrospective chart review in a tertiary pediatric center of children under the age of 18 years requiring operative drainage of a SPA as a complication of acute sinusitis. Results: There were 39 children (M 25; F 14). Ten children (26%) received antibiotic therapy prior to admission, for a median duration of 1.6 days. On presentation, 72% had rhinorrhea and/or fever, for average durations of 3.9 and 2.5 days, respectively. Streptococcal species sensitive to penicillin were grown from 51% of SPA cultures. Conclusion: Although few children in this series received antibiotics prior to their presentation with a SPA, prodromal sinusitis symptoms were of too short a duration to warrant institution of antibiotic therapy based on the American Academy of Pediatrics guidelines for acute sinusitis. Significance: SPA may not be a preventable complication of acute sinusitis in children.