JAMA
Is clavulanate necessary for adult sinusitis? Evidence says rarely
Clinical takeaway: For adults with uncomplicated acute sinusitis who need antibiotics, use standard‑dose amoxicillin first, as treatment failure is rare and comparable to amoxicillin/clavulanate. Consider reserving amoxicillin/clavulanate for patients with complicating features (e.g., recent antibiotic exposure, concern for resistant organisms, severe or recurrent disease).
Acute sinusitis has the highest rate of antibiotic prescribing in adults younger than 65 years, and amoxicillin and amoxicillin/clavulanate together account for roughly 45% of all antibiotics prescribed for this condition. Despite this high volume, there is no consensus on whether amoxicillin/clavulanate therapy offers an advantage over amoxicillin alone for uncomplicated cases.
In a retrospective cohort study published in JAMA, researchers analyzed 521,244 adults aged 18 to 64 years with a new outpatient diagnosis of acute sinusitis who were prescribed either standard‑dose amoxicillin or amoxicillin/clavulanate. After extensive propensity matching for demographics, comorbidities, and health care use, outcomes between treatment groups were nearly identical.
Treatment failure—defined as antibiotic switching or a return visit, ED encounter, or hospitalization for sinusitis or complications within 14 days—occurred in approximately 3% of patients in both groups, with no statistically significant difference. Serious treatment failures were uncommon, occurring in well under 0.1% of patients. Results were consistent across key subgroups, including patients with comorbid conditions and those considered immunocompromised.
While treatment outcomes were similar, differences emerged in safety. Patients receiving amoxicillin/clavulanate had a modestly higher risk of secondary infections, including gastrointestinal and yeast‑related events, compared with those receiving amoxicillin alone—without gains in effectiveness.
“This study reinforces that broader‑spectrum antibiotics don’t necessarily mean better care,” said Timothy J. Savage, MD, MPH. “Choosing amoxicillin when appropriate supports both patient safety and antimicrobial stewardship.”
Source: Savage TJ, et al. (2026, April 18). JAMA. Amoxicillin‑clavulanate vs amoxicillin for acute sinusitis in adults