Augmentin (Amoxicillin-Clavulanate) Treatment Duration for Acute Bacterial Sinusitis
For uncomplicated acute bacterial sinusitis in adults, prescribe amoxicillin-clavulanate 875 mg/125 mg twice daily for 5–7 days, which provides equivalent clinical efficacy to traditional 10-day courses while reducing adverse effects.
Standard Treatment Duration
A 5–7 day course of amoxicillin-clavulanate achieves clinical cure rates of 74–80% in adults with uncomplicated acute bacterial rhinosinusitis, comparable to 10-day regimens, with no difference in microbiological eradication or relapse rates. 1
The Infectious Diseases Society of America strongly recommends 5–7 days as the preferred duration for uncomplicated cases in adults, replacing older 10–14 day protocols and resulting in fewer gastrointestinal adverse events. 1
Extending therapy beyond 7 days provides no additional clinical benefit and increases the risk of diarrhea (which occurs in 40–43% of patients on amoxicillin-clavulanate, with severe diarrhea in 7–8%). 1
Dosing Specifications
Standard adult regimen: amoxicillin-clavulanate 875 mg/125 mg orally twice daily for 5–7 days (or until symptom-free for 7 consecutive days). 1, 2
High-dose regimen (for patients with recent antibiotic exposure within 4–6 weeks, age >65 years, daycare contact, moderate-to-severe symptoms, comorbidities, or immunocompromised state): amoxicillin-clavulanate 2 g/125 mg twice daily for the same 5–7 day duration. 1, 2
When to Extend Duration
Pediatric patients require 10–14 days of treatment; current pediatric data do not support shorter courses despite adult evidence favoring brief therapy. 1
Adults with complicated sinusitis involving frontal, ethmoidal, or sphenoidal sinuses should receive a full 10–14 day course. 1
If clinical response is delayed, continue therapy until symptom-free for 7 consecutive days before stopping (typically resulting in a 10–14 day total course). 1
Reassessment Protocol
Reassess at 3–5 days: If no improvement (persistent purulent drainage, unchanged facial pain, or worsening), escalate to high-dose amoxicillin-clavulanate (if not already prescribed) or switch to a respiratory fluoroquinolone (levofloxacin 500 mg daily or moxifloxacin 400 mg daily). 1
Reassess at 7 days: Persistent or worsening symptoms warrant diagnostic reconsideration, exclusion of complications (orbital cellulitis, meningitis, intracranial abscess), and possible imaging or ENT referral. 1
Only 30–41% of patients show improvement by days 3–5; zero improvement at this checkpoint indicates treatment failure requiring immediate antibiotic switch. 1
Essential Adjunctive Therapies
Intranasal corticosteroids (mometasone, fluticasone, or budesonide) twice daily significantly reduce mucosal inflammation and accelerate symptom resolution; supported by strong evidence from multiple randomized controlled trials. 1
Saline nasal irrigation 2–3 times daily provides symptomatic relief and aids mucus clearance. 1
Analgesics (acetaminophen or ibuprofen) for pain and fever control. 1
Critical Pitfalls to Avoid
Do not extend treatment beyond 7 days without clinical justification, as this raises severe diarrhea incidence (≈7–8%) without improving outcomes. 1
Maintain a minimum 5-day course even if symptoms improve earlier, to prevent relapse and resistance development. 1
**Do not prescribe antibiotics for symptom duration <10 days** unless severe features are present (fever ≥39°C with purulent nasal discharge for ≥3 consecutive days); >98% of acute rhinosinusitis cases are viral. 1
Referral Indications
Lack of improvement after 7 days of appropriate second-line therapy. 1
Development of worsening symptoms (increasing facial pain, fever, periorbital swelling, visual changes, severe headache, altered mental status). 1
Recurrent sinusitis (≥3 episodes per year) requiring evaluation for underlying allergic rhinitis, immunodeficiency, or anatomic abnormalities. 1