Antibiotics for children’s sinusitis are equally effective, with fewer side effects

Researchers at Brigham and Women’s Hospital studied the effects of two common antibiotics, amoxicillin and amoxicillin-clavulanic acid, on children with sinus infections. They found that both antibiotics were equally effective in relieving the condition. Therefore, doctors can use any of them.

However, children who took amoxicillin-clavulanic acid had more stomach problems and yeast infections. This means doctors should be careful when choosing antibiotics because some children may have more side effects from one of these antibiotics.

Lead author Timothy J., MD, MPH, MS, associate epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham, said, “This study adds the latest, actionable data and evidence to inform clinicians which antibiotics they should choose to treat children with acute bacterial sinusitis. This study shows that no matter which of these two antibiotics you choose, There was no difference in treatment failure rates either way.”

Amoxicillin-clavulanic acid is a powerful antibiotic that fights a variety of bacteria but often causes stomach problems. Researchers worry that using it too much could create antibiotic-resistant bacteria. So they wanted to see if amoxicillin or amoxicillin-clavulanic acid was better for children with sinus infections.

They looked at data from more than 320,000 children with sinusitis and compared the effectiveness of two antibiotics. Surprisingly, these two antibiotics are nearly equally effective at treating sinus infections. Rarely does it fail; most kids can be cured with different antibiotics, and only a handful need to go to the emergency room.

However, amoxicillin-clavulanic acid has more side effects. About 2.3% of children had problems such as stomach upset and yeast infections, while only 2% had problems with amoxicillin. This leads researchers to believe that amoxicillin, which has fewer side effects, may be the best option for treating sinus infections in children.

Timothy said, “Our study shows that more adverse events occur when amoxicillin-clavulanic acid is used. “Based on these data, physicians should seriously consider prescribing amoxicillin as a first line of defense in preventing acute sinusitis. “

Not all sinus infections are caused by bacteria; viruses cause some. It’s difficult to differentiate between bacterial sinus infections and viral sinus infections because they have similar symptoms. Therefore, doctors often give antibiotics to see if the infection goes away. About 85% of children with sinusitis take antibiotics; most of the time, they take amoxicillin or amoxicillin-clavulanic acid.

The study did not look at the cause of the infection (viral or bacterial) and was not a controlled experiment, meaning there could be some bias in the results. However, earlier studies from more than 20 years ago found that amoxicillin and amoxicillin-clavulanic acid worked about equally well in relieving symptoms. However, these studies included fewer patients and the bacteria changed. The new study, involving a larger number of patients, compared the current effectiveness of the two drugs.

Timothy said, “If doctors were trying to decide between these two drugs, they could look at these results and find that 98 percent of the kids got better whether they were taking amoxicillin or amoxicillin-clavulanic acid. Using these drugs The chance of a child ending up in hospital is less than 1 in 1,000. This should provide reassurance that the child will do well regardless of which antibiotic is used.”

In conclusion, this study highlights the importance of considering effectiveness and side effects when selecting antibiotics to treat sinusitis in children, with the aim of providing the best possible care for children with this disease.

Journal reference:

1. Timothy J., Matthew P. Kronman, et al. Treatment failures and adverse events after amoxicillin-clavulanic acid versus amoxicillin in pediatric acute sinusitis. Jama. DOI: 10.1001/jama.2023.15503.