Study finds amoxicillin may be first choice for sinusitis

An observational study of more than 521,000 adults reported in JAMA found similar treatment-failure and adverse-event rates for standard-dose amoxicillin and amoxicillin-clavulanate for uncomplicated acute sinusitis, while secondary infections were more common with amoxicillin-clavulanate.

An observational study published in JAMA compared outcomes for adults treated with standard-dose amoxicillin or amoxicillin‑clavulanate for uncomplicated acute sinusitis. Researchers used a national health care use database to examine patients aged 18 to 64 treated from 2018 through 2023. The full cohort included 521,244 patients, and propensity-score matching produced two groups of 117,304 patients each. The study evaluated treatment failure, antibiotic-associated adverse events, and secondary infections. Key findings: - Matched groups included 117,304 patients each (median age 43; 65.5% female). - Treatment failure occurred in 3.1% of patients given amoxicillin and 3.0% of those given amoxicillin‑clavulanate (risk ratio 0.96). - Antibiotic-associated adverse events were similar (1.2% with amoxicillin vs 1.3% with amoxicillin‑clavulanate; risk ratio 1.04). - Secondary infections were more frequent in the amoxicillin‑clavulanate group (1.2% vs 0.8%; risk ratio 1.42). - The authors reported no observed benefit to using amoxicillin‑clavulanate and noted that broader-spectrum antibiotic exposure can promote antibiotic resistance. Summary: The study authors said these results support standard‑dose amoxicillin as the preferred choice for adults with uncomplicated acute sinusitis because no clinical benefit of amoxicillin‑clavulanate was observed while secondary infections were higher with the broader agent. Undetermined at this time.