Acute Purulent Sinusitis

Clinical Features

Day time cough and headache, facial pains, nasal discharge.

• In older children severe tenderness and warmth over the sinus.
• Periorbital cellulites with oedema (rare). Complications Epidural abscess, subdural abscess, meningitis, cavernous sinus thrombosis and orbital cellulitis.

Investigation

X-ray skull, PNS (look for air fluid level, opacification)

Treatment

1. Cotrimoxazole (paediatric tablets) OR
2. Augmentin (Cloxacillin + Clavulanic acid) OR × 14-21 days
3. 2nd or 3rd Generation Cephalosporins Note: No antihistaminics and decongestants.

Croup Syndrome

It is a heterogeneous group of infectious condition characterised by: A peculiar brassy cough with or without

• Inspiratory stridor
• Hoarseness
• Respiratory distress.

Clinical Types

Clinical types are as follows: Acute Epiglottitis A potentially lethal condition unless treated early and properly.

Clinical features

Fulminating course with fever, sore throat and prolonged prostration. Progresses rapidly to respiratory obstruction within hours, ending in death if not intervened.

On examination

Dysphagia and drooling of saliva. Pharynx is inflamed with cherry red epiglottitis (this can be seen by carefully depressing the posterior portion of the tongue— risky sometimes, because the child may go into laryngeal spasm).

Diagnosis

Pharyngeal examination Investigation: X-ray of nasopharynx —shows shadow of swollen epiglottitis (thumbprint sign).

Treatment

The patient should be admitted Frequent monitoring essential

1. Start IV line with isolyte-P
2. Antibiotics (IV only)

• Ampicillin 50-100 mg/kg/d QID × 7-10 d OR
• Ceftriaxone 100 mg/kg/d BID × 7-10 d OR
• Chloramphenicol 50 mg/kg/d QID × 7-10 d

​3. O2 administration SOS

​4. Endotracheal intubation or tracheostomy if progress is rapid and respiratory distress occurs in spite of treatment.

• Adrenaline and steroids are contraindicated.