PMID- 34179886
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240402
IS  - 2688-1152 (Electronic)
IS  - 2688-1152 (Linking)
VI  - 2
IP  - 3
DP  - 2021 Jun
TI  - Comparative effectiveness of amoxicillin versus amoxicillin-clavulanate among 
      adults with acute sinusitis in emergency department and urgent care settings.
PG  - e12465
LID - 10.1002/emp2.12465 [doi]
LID - e12465
AB  - OBJECTIVE: To compare the effectiveness of amoxicillin-clavulanate versus 
      amoxicillin for adults diagnosed with acute sinusitis (AS). A secondary objective 
      compared antibiotic effectiveness in patients meeting risk criteria for treatment 
      failure. METHODS: A retrospective cohort study of adults diagnosed with AS 
      prescribed amoxicillin +/- clavulanate within Veterans Affairs emergency 
      departments from 2012-2019 was conducted. The primary outcome was 
      sinusitis-related return visits for amoxicillin versus amoxicillin-clavulanate. 
      Secondary outcomes included 30-day infectious complications, 
      gastrointestinal-related adverse events (AEs), and hospitalizations. 
      Propensity-score matching and logistic regression models adjusted for potential 
      confounders. RESULTS: A total of 89,627 AS patient visits were identified: 18,576 
      prescribed amoxicillin and 71,051 amoxicillin-clavulanate. Most patients were 
      male (75,604; 84.4%) and afebrile (80,624; 91.7%). The propensity score-matched 
      cohort comprised 17,929 amoxicillin and 42,294 amoxicillin-clavulanate patient 
      visits. There was no difference in sinusitis-related return visits between 
      amoxicillin (4.9%) and amoxicillin-clavulanate (5.1%) (adjusted odds ratio [OR], 
      0.96; 95% confidence interval [CI], 0.88, 1.04; P = 0.317). Infectious 
      complications (amoxicillin [0.3%] vs amoxicillin-clavulanate [0.4%]); (adjusted 
      OR, 0.78; 95% CI, 0.57, 1.07; P = 0.124) and hospitalization (amoxicillin [2.0%] 
      vs amoxicillin-clavulanate [2.4%]); (adjusted OR, 0.92; 95% CI, 0.81, 1.04; 
      P = 0.173) were not different. Gastrointestinal-related AEs were lower with 
      amoxicillin (0.5%) relative to amoxicillin-clavulanate (0.7%); (adjusted OR, 
      0.67; 95% CI, 0.53, 0.86; P = 0.002). Comorbidity was the only 
      guideline-recommended risk factor that was a significant predictor of infectious 
      complications with respect to treatment (amoxicillin vs amoxicillin-clavulanate, 
      OR, 0.63; 95% CI, 0.40 to 0.94; P = 0.022). CONCLUSION: Amoxicillin demonstrated 
      similar efficacy to amoxicillin-clavulanate for AS with fewer 
      gastrointestinal-related AEs. Amoxicillin is a viable option in adults with AS 
      meeting criteria for antibiotic therapy.
CI  - (c) 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of 
      American College of Emergency Physicians.
FAU - Rovelsky, Suzette A
AU  - Rovelsky SA
AD  - Boise VA Medical Center Boise Idaho USA.
FAU - Remington, Richard E
AU  - Remington RE
AD  - Quantified, Inc. Boise Idaho USA.
FAU - Nevers, McKenna
AU  - Nevers M
AD  - VA Salt Lake City Healthcare System SLC Utah USA.
AD  - University of Utah School of Medicine SLC Utah USA.
FAU - Pontefract, Benjamin
AU  - Pontefract B
AD  - Ferris State University Big Rapids Michigan USA.
FAU - Hersh, Adam L
AU  - Hersh AL
AD  - University of Utah School of Medicine SLC Utah USA.
FAU - Samore, Matthew
AU  - Samore M
AD  - VA Salt Lake City Healthcare System SLC Utah USA.
AD  - University of Utah School of Medicine SLC Utah USA.
FAU - Madaras-Kelly, Karl
AU  - Madaras-Kelly K
AD  - Boise VA Medical Center Boise Idaho USA.
AD  - Pharmacy Practice, College of Pharmacy Idaho State University Meridian Idaho USA.
LA  - eng
PT  - Journal Article
DEP - 20210616
PL  - United States
TA  - J Am Coll Emerg Physicians Open
JT  - Journal of the American College of Emergency Physicians open
JID - 101764779
PMC - PMC8208653
OTO - NOTNLM
OT  - adverse drug event
OT  - amoxicillin-clavulanate
OT  - antimicrobial stewardship
OT  - clinical outcomes
OT  - outpatient
OT  - sinusitis
EDAT- 2021/06/29 06:00
MHDA- 2021/06/29 06:01
PMCR- 2021/06/16
CRDT- 2021/06/28 06:15
PHST- 2020/11/23 00:00 [received]
PHST- 2021/02/22 00:00 [revised]
PHST- 2021/03/03 00:00 [accepted]
PHST- 2021/06/28 06:15 [entrez]
PHST- 2021/06/29 06:00 [pubmed]
PHST- 2021/06/29 06:01 [medline]
PHST- 2021/06/16 00:00 [pmc-release]
AID - EMP212465 [pii]
AID - 10.1002/emp2.12465 [doi]
PST - epublish
SO  - J Am Coll Emerg Physicians Open. 2021 Jun 16;2(3):e12465. doi: 
      10.1002/emp2.12465. eCollection 2021 Jun.