Study supports amoxicillin as first choice for sinusitis

News brief

Male patient having sinuses examined — Andrey Popov / iStock

An observational study of more than half a million adults suggests amoxicillin may be the preferred first-line treatment for uncomplicated sinusitis in adults, researchers reported late last week in JAMA.

Amoxicillin and amoxicillin-clavulanate combined account for an estimated 45% of the nearly 5 million antibiotic courses prescribed annually for sinusitis in adults under 65, but to date there has been no clear consensus of which antibiotic is the preferred first-line treatment. Some medical societies recommend amoxicillin, while others recommend either antibiotic.

To determine the optimal choice, a team led by researchers from Brigham and Women’s Hospital in Boston used a national health care use database to examine outcomes in adults aged 18 to 64 who were treated with standard-dose amoxicillin or amoxicillin-clavulanate for acute sinusitis from 2018 through 2023. The primary outcome was treatment failure; the researchers also assessed antibiotic-associated adverse events and secondary infections.

No observed benefit for amoxicillin-clavulanate

The full cohort included 521,244 patients. After patients were matched by propensity score to achieve balance in the two groups, there were 117,304 patients each (median age, 43 years; 65.5% female) in the amoxicillin and amoxicillin-clavulanate groups. The rate of treatment failure was similar in both groups, occurring in 3.0% of patients treated with amoxicillin-clavulanate and 3.1% of those who received amoxicillin only (risk ratio [RR], 0.96). Similar findings were seen across all subgroups.

There was also no difference in antibiotic-associated adverse events (1.3% vs 1.2%; RR, 1.04). But secondary infections were higher among patients in the amoxicillin-clavulanate group than in those who received amoxicillin (1.2% vs 0.8%; RR, 1.42).

“We found no observed benefit to using amoxicillin-clavulanate, which supports standard‑dose amoxicillin as the preferred choice for adults with uncomplicated acute sinusitis,” first study author Timothy Savage, MD, MPH, said in a Mass General Brigham press release.

Savage added that the findings are important because amoxicillin-clavulanate is a broad-spectrum antibiotic, and unnecessary exposure to broad-spectrum antibiotics can promote the spread of antibiotic-resistance.

“With nearly 5 million antibiotic prescriptions to adults with acute sinusitis in the U.S. each year, these findings have the potential to make a substantial impact on current treatment practices,” he said.

Hegseth removes flu vaccination requirement for US troops

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Stephanie Soucheray, MA

Today, US Secretary of Defense Pete Hegseth posted a video on social media announcing that, effective immediately, US military troops will no longer be required to receive annual flu shots.

“The notion that a flu vaccine must be mandatory for every service member, everywhere, in every circumstance, at all times, is just overly broad and not rational,” Hegseth said. “Our new policy is simple: If you, an American warrior entrusted to defend this nation, believe that the flu vaccine is in your best interest, then you are free to take it; you should. But we will not force you.”

Hegseth said vaccine requirements deny military members medical autonomy, and removing mandates restores freedom to the military.

COVID vaccine mandates were ‘betrayal’

In the video, Hegseth called mandatory COVID-19 vaccination “an era of betrayal” from the “disastrous Biden era” that’s now over. COVID-19 vaccines were required for service members from August 24, 2021, to January 10, 2023. According to the Department of Defense, more than 8,000 service members were involuntarily discharged from the military for refusing that vaccine.

It’s unclear why Hegseth made this announcement today, as flu season is winding down, and Hegseth’s focus has been on the ongoing conflict in Iran.

Public health officials reacted to today’s decision negatively. “The policy ignores warnings that more flu illness will mean more missed duty days, more hospitalizations and more preventable readiness losses,” said Richard Riccardi, PhD, of the George Washington University Center for Health Policy and Media Engagement, in a university press release. “Troops live and work in close quarters, where influenza can spread quickly and sideline otherwise healthy service member.”

Currently, the Centers for Disease Control and Prevention recommends annual flu vaccinations for everyone aged 6 months and older.

3 more H9N2 avian flu cases confirmed in China

News brief

Stephanie Soucheray, MA

boy with birds — Rusheng Yao / iStockphoto

The Hong Kong Centre for Health Protection (CHP) today reported three more H9N2 avian flu cases on mainland China, all in children under the age of 6 years. Last week, CHP recorded two cases.

While the CHP gave few details on the newly confirmed case-patients, the World Health Organization (WHO) included the three most recent cases in a new avian flu report. The first patient, a 5-year-old boy, was from Guangdong province, with symptom onset on February 23. He developed severe pneumonia and was hospitalized but is now discharged.

A girl from Yunnan province with symptom onset on March 3 and a boy from Jiangxi province who first became ill on March 20 were also infected. Both had only mild symptoms, and both are 2 years old.

5 cases in past week

According to the WHO, the older boy and the girl had exposure to poultry. The family of the 2-year-old boy reportedly visited a market where poultry had tested positive for H9 viruses.

Since 2015, a total of 162 cases of human infection with H9N2 avian flu, including two deaths (both in people with underlying conditions), have been reported to the WHO in the Western Pacific Region, the organization said. Of the 162 cases, 159 were in China.