Amoxicillin alone is comparable to its broad-spectrum cousin in treating acute sinusitis

An examination of a large commercial claims database shows that treatment failure with amoxicillin-clavulanate in pediatric acute sinusitis is similar to amoxicillin alone, but broad-spectrum antibiotics may be associated with more adverse events.

Timothy Savage, MD, MPH, MS, of Brigham University reports that the risk of treatment failure with these two commonly used antibiotics is similar (1.7% for amoxicillin-clavulanic acid and 1.8% for amoxicillin; RR 0.98, 95% CI 0.92-1.05). Boston Women’s Hospital and colleagues.

Overall, adverse events occurred in 2.3% of patients on amoxicillin-clavulanic acid and 2% of patients on amoxicillin (RR 1.15, 95% CI 1.08-1.22), with yeast infection and gastrointestinal symptoms among those receiving broad-spectrum antibiotics. More common among users, according to observational cohort study Journal of the American Medical Association.

Scott Roberts, M.D., of Yale University School of Medicine in New Haven, Conn., said in an interview that he was pleasantly surprised by the study’s results because he suspected that amoxicillin-clavulanic acid users would be affected by its broader activity for better results.

“This study reassures clinicians that amoxicillin is adequate to treat bacterial sinusitis in this day and age when many people have been vaccinated against pneumococcal disease and antibiotic resistance is more common,” said Roberts, who was not involved in the study. “Given the similar outcome data and improved side effect profile, these findings lead us to believe that amoxicillin should become a core treatment option for acute sinusitis.”

He also pointed to another benefit of the results. “I wear my antibiotic stewardship hat as I look toward a future of increasing antibiotic resistance, and this study is good news because it will avoid unnecessary antibiotic overuse and improve patient outcomes,” Roberts said.

Christopher Strother, MD, of the Icahn School of Medicine at Mount Sinai in New York City, echoed these sentiments and said the findings strengthen his own treatment plan.

“I try to avoid giving antibiotics in the first place,” he said. “If that child is doing well and can be managed by controlling symptoms, my general approach is to try to give them a chance to get better on their own as long as we keep them comfortable.”

Patients who don’t look too good, or who are “really uncomfortable or really sick, those are the people who need antibiotics, but I tend to start on amoxicillin already,” Strother said.

Savage and colleagues noted that acute sinusitis accounts for approximately 4.9 million prescriptions among U.S. children, making it one of the most common reasons for prescriptions in children, with amoxicillin and amoxicillin-clavulanic acid accounting for the majority of prescribed treatments.

There is currently no evidence-based consensus on the optimal antibiotic for acute sinusitis in children, with the Infectious Diseases Society of America recommending amoxicillin-clavulanic acid and the American Academy of Pediatrics recommending amoxicillin with or without clavulanic acid.

Additionally, Savage’s team said that since pneumococcal conjugate vaccines were first introduced in 2000, few studies have compared the two treatments. They add that since then, routine use of this vaccine and increases in antibiotic resistance may have changed the microbiology that is the culprit in acute bacterial sinusitis, which could have an impact on treatment failure rates.

This study relies on the MarketScan Commercial Claims and Encounters Database, a national health care utilization database. Investigators included 320,141 children diagnosed with acute sinusitis who received a new same-day prescription for amoxicillin-clavulanic acid or amoxicillin between 2017 and 2021.

Propensity score matching produced 99,471 matched pairs for comparison between groups. Of these matched patients, slightly more than half were 12 to 17 years old, 26% were 6 to 11 years old, and 23% were 5 years old or younger. Girls make up more than half of the group.

Patients in the amoxicillin-clavulanic acid group had a significantly higher risk of yeast infections (RR 1.33, 95% CI 1.16-1.54) and gastrointestinal symptoms (RR 1.15, 95% CI 1.05-1.25) than those in the amoxicillin group. The rate of emergency care visits was also slightly higher in the amoxicillin-clavulanic acid group, at 9.6% compared with 5.9% in the amoxicillin group.

Strother Awning Today’s Medicine Page These small increases in adverse events are fairly typical for many antibiotics.

“When you take antibiotics, you’re not only eliminating whatever infection you’re trying to treat, but you’re also eliminating a lot of the helpful healthy bacteria in your body,” he says, which can lead to more upset stomachs, diarrhea and yeast. Infect.

Savage’s group noted that there is no data on race, ethnicity and socioeconomic status. Other limitations include a lack of available microbiology data, the inability to assess medication compliance, the absence of some prescribing data, and the lack of patient weight and weight-based dosing information.