What is the recommended duration of Augmentin (amoxicillin/clavulanate) treatment for an adult patient with a bacterial sinus infection and no underlying conditions?

Augmentin Duration for Sinus Infection

For an adult with acute bacterial sinusitis, Augmentin (amoxicillin-clavulanate) should be taken for 5 to 10 days, with most guidelines recommending treatment until symptom-free for 7 days (typically 10-14 days total). 1

Standard Treatment Duration

The American Academy of Otolaryngology-Head and Neck Surgery guidelines establish 5-10 days as the recommended duration for amoxicillin-clavulanate in uncomplicated acute bacterial sinusitis. 1 However, the evidence shows that:

• Shorter courses (5-7 days) have comparable efficacy to traditional 10-day regimens with fewer adverse effects 1
• The optimal duration remains somewhat flexible because systematic reviews have not shown consistent benefits for 10 days compared with shorter courses 1
• Treatment should continue until symptom-free for 7 days, which typically results in a 10-14 day total course 1, 2, 3

Dosing Specifications

For adults with acute bacterial sinusitis, the recommended dose is:

• Standard dose: 875 mg/125 mg twice daily for most patients 1, 2
• High dose: 2 g/125 mg twice daily for patients with recent antibiotic use (within past month), age >65 years, moderate-to-severe symptoms, comorbid conditions, or immunocompromised state 2, 4

When to Reassess Treatment

Critical reassessment timepoints are essential to avoid treatment failure:

• At 3-5 days: If no improvement, switch to second-line therapy (respiratory fluoroquinolone like levofloxacin or moxifloxacin) 1, 2
• At 7 days: If symptoms persist or worsen, reconfirm diagnosis and consider complications or alternative diagnoses 1

The guideline update group emphasizes that waiting beyond 7 days to change therapy in non-responders delays effective treatment and may allow complications to develop. 1

Important Clinical Context

Before prescribing Augmentin, confirm the diagnosis meets bacterial criteria:

• Persistent symptoms ≥10 days without improvement, OR
• Severe symptoms (fever ≥39°C with purulent discharge) for ≥3 consecutive days, OR
• "Double sickening" (worsening after initial improvement from viral URI) 1, 2

Most acute rhinosinusitis (98-99.5%) is viral and resolves spontaneously within 7-10 days without antibiotics. 1

Common Pitfalls to Avoid

• Don't prescribe antibiotics for symptoms <10 days unless severe symptoms are present 1, 2
• Don't continue ineffective therapy beyond 3-5 days without reassessment 1, 2
• Don't stop antibiotics prematurely even if symptoms improve—complete the full course to prevent relapse 2, 3
• Gastrointestinal adverse effects are more common with amoxicillin-clavulanate compared to other antibiotics, particularly diarrhea (reported in 40-43% of patients, with severe diarrhea in 7-8%) 1, 5, 6

Adjunctive Therapies to Enhance Outcomes

Add these to improve symptom resolution:

• Intranasal corticosteroids (mometasone, fluticasone, or budesonide twice daily) 1, 2
• Saline nasal irrigation for symptomatic relief 1
• Analgesics (acetaminophen or ibuprofen) for pain and fever 1