Amoxicillin Produces Fewer Gastrointestinal Adverse Events for Veterans With Acute Sinusitis

Amoxicillin therapy for veterans with acute sinusitis demonstrated similar efficacy to amoxicillin-clavulanate with fewer adverse events, new research shows.

Researchers conducted a retrospective cohort study of adults with acute sinusitis prescribed amoxicillin ± clavulanate in Veterans Affairs emergency departments from 2012 to 2019. The primary outcome was sinusitis-related return visits and secondary outcomes were 30-day infectious complications, gastrointestinal-related adverse events, and hospitalizations.

Of 89,627 patient visits, 18,576 were prescribed amoxicillin, and 71,051 were prescribed amoxicillin-clavulanate. After adjusting for potential confounders using propensity-score matching and logistic regression models, 17,929 amoxicillin and 42,294 amoxicillin-clavulanate visits were included in the study.

Significant findings included:

• No difference observed in sinusitis-related return visits for amoxicillin (4.9%) and amoxicillin-clavulanate (5.1%) (adjusted odds ratio [OR], 0.96; 95% confidence interval [CI], 0.88, 1.04; P=.317).

• Infectious complications (amoxicillin [0.3%] vs amoxicillin-clavulanate [0.4%]); (adjusted OR, 0.78; 95% CI, 0.57, 1.07; P=.124) and hospitalization (amoxicillin [2.0%] vs amoxicillin-clavulanate [2.4%]); (adjusted OR, 0.92; 95% CI, 0.81, 1.04; P=.173) were not different.

• Gastrointestinal-related adverse events were less prevalent with amoxicillin (0.5%) relative to amoxicillin-clavulanate (0.7%); (adjusted OR, 0.67; 95% CI, 0.53, 0.86; P=.002).

“Clostridiodes difficile and gastrointestinal adverse events were significantly higher in patients treated with amoxicillin-clavulanate as compared with amoxicillin,” study authors noted. “Placing the study findings into clinical context, for every 500 patients treated with amoxicillin instead of amoxicillin-clavulanate 1 emergency department visit for a gastrointestinal-related adverse event could be prevented without affecting efficacy outcomes.”

Reference:
Rovelsky SA, Remington RE, Nevers McK, et al. Comparative effectiveness of amoxicillin versus amoxicillin-clavulanate among adults with acute sinusitis in emergency department and urgent care settings. JACEP Open. 2021;2:e12465. doi:10.1002/emp2.12465