Acute sinusitis is one of the most common causes for children to be put on antibiotic medications, with patients in the United States filing nearly 5 million antibiotic prescriptions every year to treat the condition. The drugs amoxicillin and amoxicillin-clavulanate make up most of those prescriptions, but there is a lack of consensus on which should be first-line for children.
and led by researchers at Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system, scientists analyzed the treatment outcomes of over 300,000 children who were prescribed either of the two drugs. They found that there was no difference in the rates of treatment failure -- that is, having to go on a new course of antibiotics or seek additional treatment for sinusitis or complications -- between patients prescribed amoxicillin and amoxicillin-clavulanate.
Amoxicillin-clavulanate is believed to treat a wider range of bacteria than amoxicillin, but it is also associated with more gastrointestinal side effects. Scientists also worry that in the long-term, overprescribing amoxicillin-clavulanate may accelerate the rate at which infectious bacteria develop antimicrobial resistance. Doctors have therefore wondered whether the benefits of prescribing amoxicillin-clavulanate to children with acute sinusitis outweigh the short- and long-term risks.
The clinical data showed that adverse events were somewhat rare but more frequent among patients treated with amoxicillin-clavulanate, occurring in 2.3% of patients treated with amoxicillin-clavulanate and 2% of patients treated with amoxicillin.
Two previous studies that compared clinical outcomes of the two drugs were conducted more than 20 years ago. Those analyses showed that both medications alleviated symptoms at similar rates, but both studies were limited by a combined sample size of under 300 patients. Bacterial species have evolved significantly in the last twenty years, a fact that convinced Savage and his team to launch a new, larger study comparing treatment failure rates of both drugs.
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