For a child with increasing symptoms of acute bacterial rhinosinusitis, what is the recommended approach?

In cases of acute bacterial rhinosinusitis in children, the diagnosis is primarily clinical, based on the history and physical examination rather than extensive testing. Symptoms typically include nasal discharge, facial pain or pressure, and sometimes fever. These are usually sufficient to guide diagnosis and treatment without the need for additional diagnostic testing like imaging or invasive procedures.

While sinus puncture and culture, Gram stain of sinus discharge, or head MRI could potentially provide more information, they are not standard practices for diagnosing acute bacterial rhinosinusitis in children due to concerns such as discomfort for the child, risk of complications, and added costs. Instead, the clinical diagnosis is often adequate, allowing healthcare providers to initiate the appropriate management, often with antibiotics if bacterial infection is suspected.