Neobook — clinical reference

ICD-10 code: J32.9

DIAGNOSTIC CRITERIA

Clinical

Signs and symptoms of complications:
- Peri-orbital swelling and fever.
Signs of meningeal irritation:
- Neck stiffness, positive Kernig’s and Brudzinski’s signs.
Signs of increased intracranial pressure:
- Hypertension, bradycardia, papilloedema and headache.
Signs of involvement of orbital structures:
- Periorbital oedema, erythema, chemosis, proptosis, vision loss and ophthalmoplegia.
Signs of brain involvement:
- Neurological signs, ataxia, paresis, paralysis, convulsions and altered level of consciousness.

Investigations

CT scan of brain, sinuses and orbits may show opacities and complications.
CT scan will show if there is involvement of intracranial structures, e.g. brain abscess and intraorbital involvement.
Pus, CSF and blood for culture and sensitivity tests. Microscopy and Gram-staining of pus and CSF specimens may give some indication of the micro-organism(s) involved.

MEDICINE TREATMENT

Empiric antibiotic therapy

Initiate empiric antibiotic therapy and reassess as soon as culture and sensitivity results become available or if there is no clinical improvement within 48–72 hours.
Ceftriaxone, IV, 100 mg/kg once daily.

As soon as there is a response and patient can tolerate oral medication:

Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly.

Total duration of therapy: 14 days.

Penicillin allergy

See: Drug Allergies, Allergies to penicillins.

For pain and fever:

REFERRAL

Urgent

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 17: Ear Nose & Throat, 17.12 Sinusitis, Complicated

Sinusitis, Complicated