From the Guidelines
Augmentin (amoxicillin-clavulanate) can be considered as a second-line treatment for sinus infections after amoxicillin has failed, given its broader spectrum of activity against beta-lactamase-producing bacteria. When prescribing Augmentin, the typical adult dosage is 875 mg amoxicillin/125 mg clavulanate twice daily or 500 mg amoxicillin/125 mg clavulanate three times daily for 5-7 days for uncomplicated cases, or up to 10-14 days for more severe or persistent infections 1. The rationale for using Augmentin as a second-line treatment is based on its ability to overcome resistance mechanisms that may render amoxicillin ineffective, as the clavulanic acid component inhibits beta-lactamase enzymes produced by some bacteria.
Key considerations when prescribing Augmentin include:
- Patient counseling on proper use, potential adverse effects, and adherence to dosing schedules
- Monitoring for common side effects such as diarrhea, nausea, and rash
- Encouraging patients to complete the full course of antibiotics even if symptoms improve before finishing the prescription
- Reevaluation if symptoms worsen or do not improve after 3 days of treatment, as indicated in the clinical practice guideline on adult sinusitis 1
It is essential to note that the decision to prescribe Augmentin should be based on a thorough reassessment of the patient, excluding other causes of illness and detecting potential complications, as outlined in the guideline 1. Additionally, patient preference, age, general health, cardiopulmonary status, and comorbid conditions should be considered in the decision-making process.
From the Research
Prescribing Augmentin for Sinus Infection After Amoxicillin
- Augmentin (amoxicillin-clavulanate) is a broad-spectrum antibacterial agent that has been used for over 20 years in the treatment of community-acquired respiratory tract infections, including sinusitis 2.
- The drug is effective against a wide range of pathogens, including beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis, as well as Streptococcus pneumoniae with reduced susceptibility to penicillin 2.
- In cases where amoxicillin has failed, Augmentin may be a suitable alternative due to its broader spectrum of activity and its ability to overcome beta-lactamase-mediated resistance 2, 3.
Efficacy of Augmentin in Sinus Infection
- Studies have shown that Augmentin is effective in the treatment of acute bacterial sinusitis, with clinical cure rates ranging from 72% to 80% 3, 4.
- Augmentin has been compared to other antibiotics, such as gatifloxacin and moxifloxacin, and has been found to be equivalent in terms of clinical and bacteriological response 3, 5.
- The drug has a well-known safety and tolerance profile, with the majority of adverse events being mild or moderate in severity 2, 3, 4, 5.
Amoxicillin Concentrations in Sinusitis
- A study found that amoxicillin concentrations in nasal secretions and paranasal sinus mucosa were sufficient to be clinically effective in patients with acute and chronic sinusitis 6.
- The study suggested that 1000 mg amoxicillin administered twice daily produces tissue concentrations high enough to be effective in patients with either acute or chronic sinusitis 6.