If a child has runny nose longer than 10 days or with confirmed sinusitis using radiological studies, the use of antibiotics may reduce clinical failure according to systematic review.
Source: Cochrane Library 2002 Issue 4: CD001094
The abstract below is a Randomized Controlled Study of sinusitis in children under 24 months old. In this study, testing of the nose discharge by bacterial culturing is useful. However, most clinicians do not do nasal culture before giving antibiotics. The diagnosis of sinusitis is difficult especially in young children because it is easily confused with allergy. There is not easy and in-expensive test to diagnose sinusitis. The diagnosis of sinusitis is by clinical history and physical examination. Some will use nasal culture.
Laryngol Otol. 2006 Oct;120(10):845-8.
Management of clinically diagnosed subacute rhinosinusitis in children under the age of two years: a randomized, controlled study.
El-Hennawi DM, Abou-Halawa AS, Zaher SR.
Otorhinolaryngology Department, Suez Canal University, Ismailia, Egypt. Dhennawi@yahoo.com
BACKGROUND: In children, a diagnosis of rhinosinusitis is usually made on clinical grounds. Subacute rhinosinusitis (SRS) may be the cause of persistent cough, low-grade fever, snoring, ear problems and difficult feeding in children under the age of two years. OBJECTIVE: To compare the efficacy of culture-based antibiotics and empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years. STUDY DESIGN: Randomized, controlled study. POPULATION: Sixty children with persistent nasal discharge and nasal obstruction (and other related symptoms) for 30-90 days. METHODS: Group one (n = 30) received culture-based antibiotics and group two (n = 30) were treated empirically with 40 mg/kg/day of amoxicillin-clavulanate. Treatment was continued for two weeks. RESULTS: At the end of the three-week follow-up period, statistically significant greater improvements in nasal obstruction (p = 0.037) and nasal discharge (p = 0.003) were seen in group one compared with group two. CONCLUSION: culture-based antibiotics were more efficacious than empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years.