What is the typical duration of treatment with Augmentin (amoxicillin/clavulanate) for bacterial sinusitis?

Duration of Augmentin for Sinusitis

For acute bacterial sinusitis, treat with Augmentin (amoxicillin-clavulanate) 875/125 mg twice daily for 10-14 days. 1, 2

Standard Treatment Duration

The guideline-recommended duration is 10-14 days for adults with acute bacterial sinusitis 3, 1. This represents the consensus across multiple international guidelines, including:

• American Academy of Allergy, Asthma, and Immunology: 10-14 days 1
• Infectious Diseases Society of America: 10-14 days 2
• French Society of Clinical Microbiology: 7-10 days 3

Treatment should continue until the patient has been symptom-free for 7 days, which typically aligns with the 10-14 day course 1, 2.

Dosing Specifics

• Standard adult dose: Augmentin 875/125 mg twice daily 3, 1, 2
• High-dose regimen (for resistant organisms or treatment failure): 90 mg/kg amoxicillin component, not exceeding 2 g every 12 hours 1, 2

When to Use High-Dose Augmentin

High-dose therapy is indicated for 3, 1:

• Recent antibiotic use within the past 4-6 weeks
• Moderate to severe disease
• Suspected resistant organisms
• Areas with high prevalence of β-lactamase-producing H. influenzae
• Treatment failure with standard-dose amoxicillin

Shorter Course Evidence vs. Guidelines

While research suggests that 5-7 days may be sufficient for uncomplicated acute maxillary sinusitis 4, and some cephalosporins have demonstrated efficacy in 5 days 3, current guidelines have not universally adopted shorter courses for Augmentin specifically. The French guidelines note that cefuroxime-axetil and cefpodoxime-proxetil have proven effective in 5 days, but maintain 7-10 days as standard for amoxicillin-clavulanate 3.

Treatment Response Assessment

Evaluate clinical response at 72 hours (3 days) 1, 2, 5:

• If no improvement or worsening: Switch to alternative antibiotic or reevaluate diagnosis
• If partial improvement: Continue full 10-14 day course 1
• If improved: Complete the full course to prevent relapse

The European data shows that Augmentin 875/125 mg twice daily for 14 days achieved significantly faster symptom improvement at days 3-5 (81% vs 56% with cefuroxime, p=0.014) and lower relapse rates at weeks 2-4 (0% vs 8%, p=0.005) 3, 2.

Special Populations

For chronic rhinosinusitis or acute exacerbations: The standard duration remains 14 days when using Augmentin 875/125 mg twice daily 3, 1.

For frontal, ethmoidal, or sphenoidal sinusitis: These more serious infections warrant the full 10-14 day course, and may require fluoroquinolones if first-line therapy fails 3.

Critical Pitfalls to Avoid

• Do not shorten the course arbitrarily: While 5-day courses show promise in research, the 10-14 day duration remains guideline-recommended for Augmentin 3, 1
• Do not stop early if symptoms improve: Incomplete courses risk relapse and resistance development 2
• Do not use standard-dose in high-resistance areas: This leads to treatment failure 3, 1

Alternative Durations by Site

For maxillary sinusitis specifically: 7-10 days is acceptable per French guidelines 3, though 10-14 days remains the safer standard 1, 2.