In a cohort of over 521,000 adults treated for acute sinusitis, amoxicillin and amoxicillin‑clavulanate showed no meaningful difference in treatment failure.1 Adverse events were uncommon overall, but amoxicillin‑clavulanate carried higher risks of secondary infections.
Patients receiving amoxicillin‑clavulanate had higher rates of yeast infections (1.1% vs 0.8%; RR 1.40) and a double rate of C difficile infection (0.04% vs 0.02%; RR 2.14), representing small absolute but clinically relevant differences (compared with pure amoxicillin). Clinicians need to specifically ask the lab for C diff toxin using a fresh loose stool. A regular stool culture does not get C diff.
In NZ, sinusitis, even when persistent symptoms of more than 3 days with fever or 10 days without fever, should first be treated symptomatically with sinus rinses and decongestants.2
As published in NZ Doctor and Research Review
