Explaining acute bacterial rhinosinusitis, the antibiotic decision and the safety-net — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the emergency department. A 5-year-old has had a runny nose and cough for twelve days after a cold, was given oral amoxicillin on day three by the family doctor for a sore ear, and over the last two days the fever has returned and the nasal discharge has become thicker and more purulent. The child is systemically well, with bilateral mucopurulent nasal discharge and no orbital or neurological signs. The parent is anxious and wants to know whether the antibiotic syrup should have worked by now, whether this is just a lingering cold, whether a new antibiotic is really needed, and what to watch for. ^[1]

Your tasks are: ^[1]

1. Explain the diagnosis of acute bacterial rhinosinusitis in plain language and why it is more than a lingering viral cold. ^[1]
2. Explain why an antibiotic is now appropriate after twelve days with worsening, having previously not been needed for the viral cold, and outline the regimen and the forty-eight to seventy-two-hour reassessment. ^{[1] [2]}
3. Explain the role of saline irrigation and the intranasal corticosteroid as part of the plan. ^[2]
4. Give a clear, specific safety-net for the signs that would mean the infection has spread towards the eye or the brain and needs urgent escalation. ^[9]

You are not expected to detail the antibiotic pharmacology to the parent, but you should explain the plan clearly and honestly, including that most children recover fully. ^[11]