Amoxicillin Vs Amoxicillin clavulanate for treating acute sinusitis in children

For treating Acute sinusitis in children both amoxicillin and amoxicillin-clavulanate were equally effective, but amoxicillin-clavulanate had higher rates of gastrointestinal symptoms and yeast infections, a recent study published in JAMA has shown.

Acute sinusitis is one of the most common causes for children to be put on antibiotic medications. The drugs amoxicillin and amoxicillin-clavulanate make up most of those prescriptions, but there is a lack of consensus on which should be first-line for children.

To fill this knowledge gap Brigham researchers analyzed the treatment outcomes of over 300,000 children who were prescribed either of the two drugs. They found that there was no difference in the rates of treatment failure — that is, having to go on a new course of antibiotics or seek additional treatment for sinusitis or complications — between patients prescribed amoxicillin and amoxicillin-clavulanate. Treatment failure was so rare, in fact, that the study’s authors say that physicians should be confident that either medication will clear a case of acute sinusitis that requires antibiotics. However, the risk of adverse events, especially gastrointestinal symptoms and yeast infections, was higher among those prescribed amoxicillin-clavulanate.

The clinical data showed that adverse events were somewhat rare but more frequent among patients treated with amoxicillin-clavulanate, occurring in 2.3% of patients treated with amoxicillin-clavulanate and 2% of patients treated with amoxicillin. Patients treated with amoxicillin-clavulanate had a 15% increased risk of gastrointestinal side effects and a 33% higher risk of yeast infections compared to patients treated with amoxicillin. The study’s authors conclude that the more narrow-spectrum amoxicillin may be the best first-line choice to combat acute sinusitis.

Reference: Savage TJ et al. “Treatment Failure and Adverse Events after Amoxicillin-Clavulanate vs. Amoxicillin for Pediatric Acute Sinusitis” JAMA DOI: 10.1001/jama.2023.15503