Table 2.

Treatment options and recommendations for children with recurrent ARS/CRS exacerbations (adapted from EPOS,32 with our own modifications90, 91, 92)

Therapy	Level	Grade of recommendation
Nasal saline irrigation	Ia	A
Topical steroids	Ia	A
Bacterial lysates (OM‐85)	Ib	A
PPI/GERD therapy	Low level evidence or no data
Topical antimycotics	Low level evidence or no data
Oral steroids	Low level evidence or no data
Probiotics	Low level evidence or no data
Short‐term antibiotics (<4 wk)	Low level evidence or no data
Intravenous antibiotics	Low level evidence or no data
Oral long‐term antibiotics	Low level evidence or no data
Decongestants	Low level evidence or no data
Mucolytics	Low level evidence or no data
Oral/topical decongestants	Low level evidence or no data
Allergen avoidance	Low level evidence or no data
Allergen immunotherapy	Low level evidence or no data
Systemic antimycotics	Low level evidence or no data

Roman numerals indicate evidence levels; capital letters indicate recommendation grades. ARS, acute rhinosinusitis; CRS, chronic rhinosinusitis; EPOS, European Position; GERD, gastroesophageal reflux disease; PPI, proton‐pump inhibitor.

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