What is the recommended Augmentin (amoxicillin/clavulanate) regimen for treating acute bacterial sinusitis in adults?

Augmentin (Amoxicillin-Clavulanate) Regimen for Adult Acute Bacterial Sinusitis

For adults with acute bacterial sinusitis, the recommended Augmentin regimen is amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days. 1

First-Line Therapy Selection

Amoxicillin-clavulanate is the preferred antibiotic choice for acute bacterial rhinosinusitis (ABRS) in adults rather than amoxicillin alone, based on current guidelines:

• The Infectious Diseases Society of America (IDSA) recommends amoxicillin-clavulanate over amoxicillin alone for empiric therapy of ABRS in adults 1
• The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines support amoxicillin with or without clavulanate as first-line therapy 1

Dosing Options

Two main dosing options exist for adult ABRS:

1. Standard-dose regimen:

   • Amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days 1, 2

2. High-dose regimen:

   • Amoxicillin-clavulanate 2000 mg (amoxicillin component) with 125 mg clavulanate orally twice daily for 5-7 days 1, 2

The high-dose regimen should be considered in the following situations:

• Areas with high prevalence of resistant S. pneumoniae (>30%)
• Severe infection
• Patients at risk for resistant pathogens
• Immunocompromised hosts
• Recent antibiotic use (past 30 days)
• Treatment failure with standard dosing 1, 2

Duration of Therapy

The recommended duration of therapy for uncomplicated ABRS in adults is 5-7 days 1, 2. This shorter duration is supported by:

• IDSA guidelines specifically recommend 5-7 days for adults 1
• AAO-HNS guidelines recommend 5-10 days, with evidence supporting the shorter end of this range 1
• Meta-analyses showing similar effectiveness of short-course (5-7 days) compared to longer-course (10-14 days) antibiotic treatment for ABRS 3

In contrast, children with ABRS should receive a longer treatment duration of 10-14 days 1, 2.

Treatment Failure

If a patient fails to improve after 7 days of initial antibiotic therapy or worsens during treatment:

1. Reassess to confirm ABRS diagnosis and exclude complications
2. Change to a different antibiotic class rather than extending the same treatment 1, 2
3. Consider high-dose amoxicillin-clavulanate if standard dose was initially used 4

Adjunctive Therapies

Several adjunctive therapies may be beneficial alongside antibiotic treatment:

• Recommended:

  • Intranasal saline irrigation (physiologic or hypertonic) 1, 2
  • Intranasal corticosteroids, especially in patients with history of allergic rhinitis 1, 2

• Not recommended:

  • Topical or oral decongestants 1
  • Antihistamines 1

Common Pitfalls to Avoid

1. Using fluoroquinolones as first-line therapy instead of amoxicillin-clavulanate
2. Treating for longer than necessary (exceeding 7 days in adults)
3. Failing to change antibiotic class when initial therapy fails
4. Not considering high-dose regimen in appropriate situations
5. Treating viral upper respiratory infections as bacterial sinusitis
6. Not reassessing after 72 hours if symptoms worsen 2

By following these evidence-based recommendations for Augmentin therapy in adult ABRS, clinicians can optimize treatment outcomes while minimizing adverse effects and antibiotic resistance.