What is the recommended course of Augmentin (amoxicillin-clavulanate) for a sinus infection?

Augmentin Treatment for Sinus Infection

For adults with acute bacterial sinusitis, Augmentin (amoxicillin-clavulanate) should be prescribed at a dose of 875/125 mg twice daily for 5 to 10 days. 1, 2

First-Line Treatment Approach

• Clinicians should consider either watchful waiting or prescribing antibiotics for uncomplicated acute bacterial rhinosinusitis (ABRS) 1
• If antibiotics are chosen, amoxicillin with or without clavulanate is recommended as first-line therapy for most adults 1, 3
• Augmentin should be used in scenarios such as moderate to severe illness, recent antibiotic use, treatment failure with amoxicillin alone, or areas with high prevalence of β-lactamase-producing H. influenzae 3, 4

Specific Dosing Recommendations

• For adults with sinus infections, the FDA-approved dose is 875/125 mg twice daily for respiratory tract infections 2
• For more severe infections, the 875/125 mg formulation given twice daily is preferred over the 500/125 mg formulation given three times daily 2, 5
• High-dose regimens have not consistently shown superior efficacy compared to standard dosing for acute sinusitis 6, 7

Treatment Duration

• The standard treatment duration is 5 to 10 days, as recommended by the 2015 Clinical Practice Guideline 1
• While traditional recommendations were for 10-14 days, shorter courses may be equally effective with fewer side effects 1, 8
• The American Academy of Otolaryngology-Head and Neck Surgery recommends continuing antibiotics until the patient has been symptom-free for 7 days 4

Treatment Response Assessment

• Evaluate response after 72 hours (3 days) of treatment 3, 4
• If the patient fails to improve by 7 days after diagnosis or worsens during initial management, the clinician should reassess to confirm ABRS, exclude other causes, and detect complications 1
• If the patient was initially managed with an antibiotic and fails to improve, the clinician should change the antibiotic 1

Common Pitfalls to Avoid

• Treating viral sinusitis with antibiotics is inappropriate and contributes to antibiotic resistance 3, 4
• Not completing the full course of antibiotics can lead to incomplete eradication and potential relapse 4
• Using standard-dose amoxicillin in areas with high resistance patterns may lead to treatment failure 4

Alternative Options for Penicillin-Allergic Patients

• For patients allergic to or intolerant of amoxicillin-clavulanate, alternatives include cephalosporins (if no history of anaphylaxis to penicillin), doxycycline, and respiratory fluoroquinolones 3, 9
• Macrolides like azithromycin may be considered but have shown variable efficacy compared to Augmentin 10
• Fluoroquinolones should be reserved for situations where major complications are likely or after failure of first-line therapy 1

Adjunctive Therapies

• Corticosteroids may be useful if given for a short period as adjuvant therapy in acute hyperalgic (very painful) sinusitis 1
• The role of antihistamines in acute bacterial sinusitis is not well established 1
• Decongestants are often used but have limited systematic study in sinusitis 1