What is the dose of Amoxicillin (Amoxi) Clavulanate (Clav) for acute sinusitis?

From the Guidelines

For a sinus infection, the recommended dose of amoxicillin-clavulanate is 500-875 mg taken twice daily for 5-7 days in adults, and 22.5-45 mg/kg taken twice daily in children, based on the amoxicillin component 1.

Key Considerations

• The dosage may vary depending on the severity of the infection and the patient's medical history.
• It is essential to complete the entire course of treatment, even if symptoms improve before finishing the medication.
• Amoxicillin-clavulanate is effective against many bacteria that cause sinus infections, including those resistant to amoxicillin alone.
• Common side effects include diarrhea, nausea, and rash, and patients should contact their doctor if they experience severe diarrhea or allergic reactions.

Treatment Guidelines

• The American Academy of Pediatrics recommends amoxicillin-clavulanate as a first-line treatment for acute bacterial sinusitis in children, with a dosage of 45 mg/kg per day in 2 divided doses for mild to moderate infections, and 80-90 mg/kg per day in 2 divided doses for more severe infections 1.
• The Infectious Diseases Society of America also recommends amoxicillin-clavulanate as a first-line treatment for acute bacterial sinusitis in children and adults.

Important Notes

• Patients should take the medication with food to reduce stomach upset.
• Staying hydrated and using saline nasal irrigation can help support recovery while taking this antibiotic.
• It is crucial to follow the prescribed dosage and treatment duration to ensure effective treatment and minimize the risk of antibiotic resistance.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. The recommended dose for sinus infection is:

• One 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours
• One 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours 2

From the Research

Amoxicillin-Clavulanate Dose for Sinus Infection

• The dose of amoxicillin-clavulanate for sinus infection is typically high-dose, with 875 mg of amoxicillin and 125 mg of clavulanate taken twice a day for 7 days 3.
• However, a study found that high-dose amoxicillin plus clavulanate may not be superior to standard-dose amoxicillin plus clavulanate in adults with acute sinusitis 3.
• Another study suggests that amoxicillin-clavulanate is an appropriate therapy for acute bacterial sinusitis, especially in penicillin-allergic patients or those who are unresponsive to amoxicillin 4.
• The optimal duration of therapy is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 4.

Alternative Treatments

• Alternative treatments for sinus infection include cefuroxime, cefpodoxime, or cefdinir 4.
• Cefdinir has been shown to be effective in the treatment of acute bacterial rhinosinusitis, with efficacy similar to that of amoxicillin/clavulanate and levofloxacin 5.
• Short-course antibiotic therapy (less than or equal to 5 days) may have equivalent or superior efficacy compared to traditional longer therapies (10-14 days) 6.

Important Considerations

• The diagnosis of acute bacterial sinusitis should be confirmed with images and appropriate antibiotics should be prescribed 4.
• The predominant bacterial species implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 4.
• The increasing prevalence of penicillin-resistant S. pneumoniae, and beta-lactamase-producing H. influenzae and M. catarrhalis should be considered when choosing an antibiotic regimen 4.