Acute bacterial rhinosinusitis (ABRS), defined as a bacterial infection of the nasal cavity and one or more sinuses persisting for less than 4 weeks, is a common diagnostic consideration in pediatric care. Nearly 5 million US children are prescribed antibiotics for ABRS annually in ambulatory settings. The Infectious Diseases Society of America (IDSA)¹ and American Academy of Pediatrics (AAP)² published guidelines for management of ABRS in 2012 and 2013, respectively. However, these guidelines are more than 10 years old and they differ in their recommendations for first-line antibiotic therapy. The IDSA recommends amoxicillin-clavulanate and the AAP recommends amoxicillin or amoxicillin-clavulanate. This article reviews antibiotic selection for ABRS, considering evidence published since 2013.