Comparative Study on Antibiotic Use for Acute Sinusitis

Researchers at Mass General Brigham carried out a comprehensive national study on antibiotic use for treating acute sinusitis, revealing no significant differences in outcomes between patients receiving amoxicillin and those treated with amoxicillin-clavulanate. Acute sinusitis often leads to antibiotic prescriptions in U.S. adults, but there is no distinct preference for a specific antibiotic in uncomplicated cases. The study, involving over 500,000 adult patients, found that while amoxicillin-clavulanate did not significantly improve treatment outcomes over amoxicillin, it was linked to a slight increase in secondary infection risk. These findings were published in JAMA. Timothy Savage, MD, MPH, MSc, the study’s corresponding author and an associate epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at Mass General Brigham, emphasized the potential to reduce antibiotic resistance by limiting the use of broader-spectrum antibiotics. He noted that amoxicillin and amoxicillin-clavulanate together account for about 45% of acute sinusitis prescriptions, highlighting the importance of determining the most effective treatment. The study supports the use of standard-dose amoxicillin as the preferred treatment for uncomplicated cases of acute sinusitis. Clavulanate is known for inhibiting an enzyme that grants bacteria resistance against amoxicillin; however, not all bacteria involved in acute sinusitis produce this enzyme. This study utilized insurance claims data from January 2018 to December 2023, analyzing outcomes for 521,244 adults aged 18-64. It evaluated the risk of treatment failure—including the need to switch antibiotics or revisit healthcare services—and adverse events. Treatment failure was infrequent for both antibiotics, observed at about 3%. Even among immunocompromised patients, who may benefit from amoxicillin-clavulanate, no significant treatment failure differences were noted. Though the risk of antibiotic-related adverse events was consistent across both groups, a slight increase in secondary infections was noted in those treated with amoxicillin-clavulanate. Savage highlighted the potential impact of these findings on treatment protocols, given the millions of prescriptions for acute sinusitis issued annually in the U.S. Future research aims to better identify patients who would benefit from antibiotics versus those with viral infections who may respond well to supportive care. The study enlisted several co-authors alongside Savage, including Anne M. Butler, Matthew P. Kronman, Michael J. Durkin, Sushama Kattinakere Sreedhara, Sarah Kabbani, Lauri A. Hicks, and Krista F. Huybrechts. This research received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the U.S. Centers for Disease Control and Prevention.