From the Guidelines
For a URI that may be bacterial at this point, I recommend prescribing amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults, as stated in the clinical practice guideline update for adult sinusitis 1. When diagnosing a patient with a URI, it is essential to distinguish between viral rhinosinusitis (VRS) and presumed acute bacterial rhinosinusitis (ABRS) based on illness pattern and duration. The criteria for diagnosing ABRS include symptoms or signs of ARS that persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms, or symptoms or signs of ARS that worsen within 10 days after an initial improvement (double worsening) 1. Key considerations for managing ABRS include:
- Offering watchful waiting (without antibiotics) or prescribing initial antibiotic therapy for adults with uncomplicated ABRS, with assurance of follow-up to start antibiotic therapy if the patient’s condition fails to improve by 7 days after ABRS diagnosis or if it worsens at any time 1.
- Prescribing amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults 1.
- Reassessing the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management 1. It is crucial to note that the choice of antibiotic for ABRS should be based on the most recent and highest-quality evidence, and amoxicillin with or without clavulanate is currently recommended as first-line therapy 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium tablets USP, and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria Amoxicillin and clavulanate potassium tablets USP is a combination penicillin-class antibacterial and beta-lactamase inhibitor indicated in the treatment of infections due to susceptible isolates of the designated bacteria in the conditions listed below*: 1.1 Lower Respiratory Tract Infections – caused by beta-lactamase–producing isolates of Haemophilus influenzae and Moraxella catarrhalis. 1.3 Sinusitis – caused by beta-lactamase–producing isolates of H. influenzae and M. catarrhalis.
The recommended antibiotic for a URI that may be bacterial is amoxicillin-clavulanate if it is suspected to be caused by beta-lactamase–producing isolates of Haemophilus influenzae or Moraxella catarrhalis 2.
- Key considerations:
- The infection should be proven or strongly suspected to be caused by susceptible bacteria.
- Culture and susceptibility information should be considered when available.
- In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
From the Research
Antibiotic Recommendations for URI
- The choice of antibiotic for a suspected bacterial URI depends on various factors, including the severity of symptoms, patient age, and local resistance patterns 3, 4.
- Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been widely used for community-acquired respiratory tract infections, including URI 3.
- For acute otitis media, amoxicillin is the drug of choice, while amoxicillin/clavulanate provides better coverage against beta-lactamase-producing pathogens 4.
- In cases of acute bacterial sinusitis, amoxicillin is the recommended antibiotic 4, 5.
- Antibiotics should not be used for viral URIs, such as the common cold, influenza, or COVID-19 5, 6.
Key Considerations
- Early antibiotic treatment may be indicated in patients with acute otitis media, group A beta-hemolytic streptococcal pharyngitis, or epiglottitis 5, 6.
- Judicious use of antibiotics is essential to prevent adverse effects, contain costs, and reduce the risk of antibiotic resistance 5, 6.
- Evidence-based strategies, such as symptom alleviation and prevention of URTI virus transmission, can help manage URI effectively 7.