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In a large observational study of 521,244 adults with acute sinusitis published in JAMA, researchers found outcomes were similar between patients treated with standard-dose amoxicillin-clavulanate and those treated with standard-dose amoxicillin. The study compared outpatient outcomes from 2018 through 2023 for new users of amoxicillin-clavulanate (875–125 mg, 2 times daily) or amoxicillin (875 mg twice daily or 500 mg, 3 times daily). Treatment failure was low overall (3.1%) and did not differ between groups. Only 0.03% of patients required emergency or inpatient care. However, amoxicillin-clavulanate was associated with slightly higher rates of secondary infections, including yeast infections (1.1% vs 0.8%, risk ratio [RR] 1.40, 95% confidence interval [CI] 1.29-1.53) and C difficile infection (0.04% vs 0.02%, RR 2.14, 95% CI 1.29-3.54), although absolute risks were small.Â
Preferred choice: The authors say while there traditionally has been no consensus regarding whether amoxicillin-clavulanate or amoxicillin should be the first-line treatment for uncomplicated acute sinusitis in adults, the research results suggest amoxicillin may be the preferred option. The 2 drug treatments account for about 45% of antibiotic prescriptions for acute sinusitis outpatient visits in adults.
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