Can I give dexamethasone with Augmentin (amoxicillin/clavulanate) to treat a sinus infection?

Dexamethasone with Augmentin for Sinus Infection

Yes, dexamethasone can be given with Augmentin (amoxicillin/clavulanate) for sinus infection treatment, as corticosteroids can provide additional symptom relief when combined with antibiotics for acute bacterial sinusitis. 1, 2

Antibiotic Treatment

• Augmentin (amoxicillin/clavulanate) is a first-line antibiotic treatment for bacterial sinusitis:

  • Standard dose: 875/125 mg twice daily for 5-7 days 1
  • High-dose option: 2000 mg (amoxicillin component) with 125 mg clavulanate twice daily for 5-7 days 1

• Amoxicillin/clavulanate is particularly effective against common sinus pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, including those that produce beta-lactamase 3

Role of Corticosteroids

• Intranasal corticosteroids are recommended as adjunctive treatment for bacterial sinusitis according to multiple guidelines 1

• Systemic corticosteroids (like dexamethasone) can help reduce inflammation, decrease nasal swelling, and improve sinus aeration 4

• Research shows that adding corticosteroids to antibiotic therapy provides significantly greater symptom relief, particularly for:

  • Headache
  • Facial pain
  • Nasal congestion 2

Evidence for Combination Therapy

A randomized clinical trial demonstrated that adding intranasal corticosteroids to amoxicillin/clavulanate produced additional symptom relief in acute sinusitis compared to antibiotic treatment alone 2. The study showed:

• Greater decrease in total symptom scores
• Improved relief of inflammatory symptoms
• Better management of obstruction-related symptoms

Treatment Algorithm

1. Confirm bacterial sinusitis diagnosis based on:

   • Persistent symptoms >10 days without improvement
   • Severe symptoms with high fever and purulent discharge
   • Worsening symptoms after initial improvement 1

2. Start Augmentin at appropriate dosage:

   • 875/125 mg twice daily for 5-7 days (standard dose)
   • Consider high-dose formulation for severe cases 1, 5

3. Add dexamethasone for additional symptom relief:

   • Short course (typically 3-5 days)
   • Helps reduce inflammation and improve sinus drainage

4. Include other adjunctive treatments:

   • Saline nasal irrigation
   • Adequate hydration
   • Acetaminophen or ibuprofen for pain/fever 1

5. Assess response within 72 hours of starting treatment:

   • If no improvement, consider changing antibiotics
   • If symptoms worsen, evaluate for complications 1

Important Considerations

• Corticosteroids primarily help with inflammatory symptoms (congestion, facial pain, headache) rather than secretory symptoms 2

• Short-term use of dexamethasone is generally well-tolerated when combined with antibiotics

• Be cautious in patients with diabetes, as dexamethasone can affect blood glucose levels

• The FDA-approved indication for amoxicillin/clavulanate includes treatment of acute bacterial sinusitis in both adults and children 6

Potential Pitfalls

• Avoid prolonged courses of dexamethasone, as extended systemic corticosteroid use increases risk of adverse effects

• Monitor for gastrointestinal side effects, as high-dose amoxicillin/clavulanate can cause severe diarrhea in some patients (15.8% with high-dose vs 4.8% with standard dose) 5

• Ensure the diagnosis is truly bacterial sinusitis rather than viral rhinosinusitis, as antibiotics are not indicated for viral infections 1