Criteria for additional outpatient observation: “Persistent illness: The clinician should either prescribe antibiotic therapy OR offer additional outpatient observation for 3 days to children with persistent illness (nasal discharge of any quality or cough or both for at least 10 days without evidence of improvement) (Evidence Quality: B; Recommendation).”

Additional outpatient observation, defined as initial management of acute bacterial sinusitis limited to continued observation for 3 days, with commencement of antibiotic therapy if either the child does not improve clinically within several days of diagnosis or if there is clinical worsening of the child’s condition at any time.

Reference: AAP Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 years. Pediatrics, 2013.