A large observational study published in JAMA found that there is no significant difference in treatment failure rates between the two most commonly prescribed antibiotics for pediatric acute sinusitis. The study, led by researchers from Brigham and Women’s Hospital in Boston, compared the outcomes of children who received amoxicillin or amoxicillin-clavulanate for acute sinusitis. The researchers found that treatment failure for sinus infections was rare in both groups, but amoxicillin-clavulanate was associated with more adverse events.
Amoxicillin and amoxicillin-clavulanate are the two most commonly prescribed antibiotics for pediatric acute sinusitis, accounting for 65% of antibiotics prescribed. The primary difference between the two is that amoxicillin-clavulanate has clavulanate, which inhibits certain beta-lactamase enzymes and allows it to target a broader spectrum of bacteria. However, there has been a lack of consensus on which antibiotic is the optimal choice.
The study used data from a large commercial insurance database and analyzed 320,141 children with acute sinusitis. Researchers defined treatment failure as the need for additional antibiotic dispensation, emergency department or inpatient encounters for acute sinusitis, or inpatient encounters for sinusitis complications. They found no significant difference in the risk of treatment failure between the two antibiotics. However, the risk of gastrointestinal symptoms and yeast infections was higher with amoxicillin-clavulanate.
Based on these findings, the study authors suggest that physicians should consider prescribing amoxicillin as a first-line treatment for acute sinusitis. The lead author of the study, Dr. Timothy Savage, emphasizes that regardless of the antibiotic used, most children with acute sinusitis will improve. However, the increased risks associated with amoxicillin-clavulanate, such as gastrointestinal symptoms and yeast infections, favor the use of amoxicillin.
It is important to note that exposure to broad-spectrum antibiotics, including amoxicillin-clavulanate, has been associated with an increased risk of antibiotic-resistant infections. Therefore, the results of this study should be interpreted in the context of other studies highlighting the potential risks of broad-spectrum antibiotics.
– Original article: JAMA
– Study authors: Brigham and Women’s Hospital