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The viral upper respiratory tract infection (URI) is the most common illness for which children present to the primary care pediatrician. Approximately 5% to 10% of viral URIs are complicated by acute bacterial sinusitis. Sinusitis results in more than $5.8 billion in health care expenditures in the United States annually, of which $1.8 billion is spent on children younger than 13 years. (1) The diagnosis and treatment of acute bacterial sinusitis present unique challenges to the primary care physician in the acute care setting.

The ethmoid and maxillary sinuses develop in the third month of gestation and, although small, are present at birth. The frontal sinuses develop from an anterior ethmoidal air cell and are pneumatized by age 5 or 6 years. The sphenoid sinus starts to become aerated at age 5 years and expands in size into the...

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