Treatment Failure Similar for Amoxicillin +/− Clavulanate for Pediatric Acute Sinusitis

However, amoxicillin-clavulanate tied to higher risk for adverse events, particularly in younger children
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Medically Reviewed By :
Meeta Shah, M.D.

THURSDAY, Sept. 21, 2023 (HealthDay News) -- There is no difference in the risk for treatment failure for outpatient children with acute sinusitis treated with amoxicillin-clavulanate compared with amoxicillin, according to a study published in the Sept. 19 issue of the Journal of the American Medical Association.

Timothy J. Savage, M.D., from Brigham and Women’s Hospital in Boston, and colleagues compared amoxicillin-clavulanate versus amoxicillin for the treatment of acute sinusitis in outpatient children. The analysis included 198,942 propensity-matched patients (aged 17 years and younger).

The researchers observed no difference in the risk for treatment failure between the amoxicillin-clavulanate and amoxicillin groups (relative risk [RR], 0.98; 95 percent confidence interval [CI], 0.92 to 1.05). However, with amoxicillin-clavulanate, the risk for gastrointestinal symptoms (RR, 1.15; 95 percent CI, 1.05 to 1.25) and yeast infections (RR, 1.33; 95 percent CI, 1.16 to 1.54) was higher. Risk for treatment failure with amoxicillin-clavulanate varied by age (ages 0 to 5 years: RR, 0.98; 95 percent CI, 0.86 to 1.12; 6 to 11 years: RR, 1.06; 95 percent CI, 0.92 to 1.21; and 12 to 17 years: RR, 0.87; 95 percent CI, 0.79 to 0.95). The risk for adverse events with amoxicillin-clavulanate decreased with age (0 to 5 years: RR, 1.23; 95 percent CI, 1.10 to 1.37; 6 to 11 years: RR,1.19; 95 percent CI, 1.04 to 1.35; and 12 to 17 years: RR, 1.04; 95 percent CI, 0.95 to 1.14).

"These findings may help inform decisions for empirical antibiotic selection in acute sinusitis," the authors write.

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