Acute Bacterial Rhinosinusitis Clinical Pathway, Primary Care, Emergency Department and Inpatient – Shared Decision-Making

Acute Bacterial Rhinosinusitis Clinical Pathway – Primary Care, Emergency Department and Inpatient

Shared Decision-Making

  • Observation without antibiotics is preferred for most children with persistent symptoms (nasal drainage and daytime cough lasting more than 10 days without improvement) or worsening symptoms (symptoms worsen more than 5-6 days into viral URI; “double sickening”) who do not meet criteria for severe disease.
    • Consider antibiotics for children at higher risk of severe disease, including those with
      severe asthma.
  • Serious complications of sinusitis are extremely rare and there is no clear evidence that antibiotics prevent those complications.

Guidance for Communicating with Families When Antibiotics Are Not Prescribed

  • Conversations around antibiotics are important. Dialogue Around Respiratory Illness Treatment (DART)   is an evidence-based online communication skills and antibiotic prescribing education training program designed to improve conversations with parents and caregivers when antibiotics are not indicated.
  • There are 4 key steps to improve communication, especially when a caregiver may expect an antibiotic but the provider does not think one is necessary. These steps have been shown to improve caregiver satisfaction when antibiotics are not prescribed:
    • 1
      • Review physical examination findings aloud
        • “Her lungs sound clear and there is no evidence of bacterial pneumonia.”
      2
      • Provide the family with a clear diagnosis
        • “However, she does have a viral respiratory tract infection, or a bad cold.”
      3
      • Use positive treatment recommendations
        • “Unfortunately, antibiotics will not help her get better faster, but there are some things you can do to make her feel better, including using ibuprofen for fevers, a humidifier, or honey for her cough.”
      4
      • Provide a contingency plan, like instructions for when to return to care
        • “Right now, there are no signs of a bacterial infection that needs antibiotics, but things can always change. If her fevers persist for more than 5 days or she isn’t starting to feel better in the next 48-72 hrs, I want you to call the office.”