In a study of 320,141 children published in JAMA Network, researchers found those treated with amoxicillin-clavulanate had a slightly higher risk of treatment failure (defined as lack of effectiveness or intolerability) compared with amoxicillin. And for those treated with amoxicillin-clavulanate, there was also a higher risk of gastrointestinal symptoms and yeast infections. Accessing treatment in urgent care was more common among patients who received amoxicillin-clavulanate (9.6%) than those who received amoxicillin (5.9%), and urgent care was the second-most common type of care setting overall, second to outpatient offices. The relative risk of treatment failure for the amoxicillin-clavulanate group compared to the amoxicillin group was 1.10 (95% confidence interval [CI], 1.05-1.16). The risk of gastrointestinal symptoms (relative risk [RR], 1.15 [95% CI, 1.05-1.25]) and yeast infections (RR, 1.33 [95% CI, 1.16-1.54]) was higher with amoxicillin-clavulanate. In the study sample, more than 90% of patients were dispensed 10 or more days of antibiotics.
Everyday practice: The American Academy of Pediatrics recommends amoxicillin with or without clavulanate as first-line antibiotic treatment for acute sinusitis, and overall, treatment failure is rare, the authors say.