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Acute rhinosinusitis in a child with signs and symptoms of a cold that persist beyond 10 days is recommended to be treated with antimicrobials. One reason for this recommendation is to prevent the complications of sinus infection. We wanted to find out whether there is any evidence to support this.We reviewed retrospectively all the medical records of children treated in our hospital from February 1996 to March 2006 for complications related to rhinosinusitis.Twenty children had such complications. Their symptoms of uncomplicated acute respiratory infection had lasted for an average of 5.1 days before the appearance of the complication, and only 3 children had respiratory symptoms lasting longer than 10 days.Complications of rhinosinusitis in children appear during the first few days of acute upper respiratory infection. This finding does not support the recommendation that antibiotics should be started if upper respiratory symptoms have lasted longer than 10 days in children. Even though patients with findings suggesting invasive periorbital infection require immediate antimicrobial treatment, we should be critical in our recommendations as to when antibiotics need to be given to patients with only prolonged upper respiratory infections.