Augmentin for Bacterial Sinus Infections
Yes, Augmentin (amoxicillin-clavulanate) is highly effective for treating bacterial sinus infections, with predicted clinical efficacy of 90-92% and bacteriologic efficacy of 97-99%, making it the recommended first-line antibiotic therapy. 1
When to Use Augmentin
For adults with mild acute bacterial sinusitis who have not received antibiotics in the previous 4-6 weeks, standard-dose amoxicillin/clavulanate (1.75-4 g/250 mg per day) is recommended as first-line therapy. 1
For adults with moderate disease or those who received antibiotics in the past 4-6 weeks, high-dose amoxicillin/clavulanate (4 g/250 mg per day) provides 91% predicted clinical efficacy and 99% bacteriologic efficacy. 1
For children, a high-dose regimen of 90 mg/6.4 mg per kg per day is recommended as first-line therapy, with predicted clinical efficacy ranging from 91-92%. 1
Microbiologic Coverage
Augmentin demonstrates excellent activity against the primary pathogens causing bacterial sinusitis:
- 92.1% susceptibility against all Streptococcus pneumoniae strains 1
- 98.3% susceptibility against Haemophilus influenzae 1
- 100% susceptibility against Moraxella catarrhalis 1
This broad coverage is particularly important given the increasing prevalence of beta-lactamase-producing organisms and penicillin-resistant S. pneumoniae. 2, 3
Comparative Effectiveness
Multiple randomized controlled trials demonstrate Augmentin's effectiveness:
In chronic rhinosinusitis, Augmentin showed comparable clinical cure rates to ciprofloxacin (51.2% vs. 58.6%) and similar bacteriologic clearance rates (90.5% vs. 88.9%). 4
Compared to cefuroxime, Augmentin demonstrated significantly faster symptom improvement at days 3-5 (81% vs 56%; p=0.0137) and significantly lower clinical relapse rates at weeks 2-4 (0% vs. 8%; p=0.0049). 4
Compared to clarithromycin, Augmentin showed similar clinical success rates (93% vs. 97%) but with comparable bacteriologic cure rates (90% vs. 87%). 5
Duration of Therapy
Treat for 10-14 days for most patients with acute bacterial sinusitis. 4 Some experts recommend continuing treatment until the patient is symptom-free plus an additional 7 days. 4, 2
When to Switch Therapy
Assess response at 72 hours. If no improvement or worsening occurs, switch to a respiratory fluoroquinolone (levofloxacin, moxifloxacin) or ceftriaxone, which provide 92% clinical efficacy and 100% bacteriologic efficacy as second-line options. 1
If there is no clinical improvement within 3 days of initiating antimicrobial therapy, an alternative antibiotic should be considered. 4
Common Pitfalls to Avoid
Do not use macrolides (azithromycin, clarithromycin) as first-line therapy due to only 77% predicted efficacy and high resistance rates. 1
Do not use TMP/SMX due to high resistance rates, with only 63.7% susceptibility against S. pneumoniae. 1
For patients with penicillin allergy:
- Non-Type I hypersensitivity: Use cefdinir, cefuroxime axetil, or cefpodoxime proxetil (83-87% efficacy). 1
- Type I penicillin allergy: Use respiratory fluoroquinolones (levofloxacin 500-750 mg daily) which provide 92% efficacy. 1
Tolerability
The most common adverse event is diarrhea, occurring in approximately 25-38% of patients, though most cases are mild to moderate. 4, 5 The extended-release formulation (Augmentin XR) maintains the same safety profile as conventional formulations. 3