Amoxicillin-Clavulanate vs Amoxicillin for Acute Sinusitis in Adults

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Acute sinusitis is frequently treated with antibiotics in adults.
• Current guidelines lack consensus on first-line antibiotic choice between amoxicillin-clavulanate and amoxicillin.
• Understanding comparative effectiveness and safety is crucial for optimal patient care.

Purpose of the Study:

• To compare treatment failure and adverse events between amoxicillin-clavulanate and amoxicillin for uncomplicated acute sinusitis in adults.
• To evaluate the safety and efficacy of these two common antibiotic regimens.
• To inform clinical decision-making regarding first-line antibiotic therapy.

Main Methods:

• Retrospective cohort study utilizing a nationwide healthcare database.
• Included adults aged 18-64 with outpatient acute sinusitis diagnosis (2018-2023).
• Propensity score matching used to compare standard-dose amoxicillin-clavulanate versus amoxicillin, analyzing treatment failure and adverse events.

Main Results:

• No significant difference in treatment failure rates between amoxicillin-clavulanate (3.0%) and amoxicillin (3.1%) groups (RR, 0.96; 95% CI, 0.92-1.01).
• Similar rates of antibiotic-associated adverse events observed between the two groups (1.3% vs 1.2%).
• Amoxicillin-clavulanate was associated with a higher risk of secondary infections, including yeast infections and C. difficile infections.

Conclusions:

• Standard-dose amoxicillin-clavulanate and amoxicillin demonstrate comparable efficacy for uncomplicated acute sinusitis in adults.
• Amoxicillin-clavulanate is linked to an increased risk of specific adverse events, particularly secondary infections.
• Findings suggest amoxicillin may be a preferable first-line treatment option for adults with uncomplicated acute sinusitis.