Acute bacterial sinusitis accounts for 5 million antibiotic prescriptions for children in the United States yearly, with roughly 65% involving Amoxicillin or Amoxicillin-clavulanate. A significant majority of pediatric patients receive antibiotic courses lasting 10 days or more.

To date, no research has directly compared shorter versus longer therapy durations. This large cohort study specifically investigated the efficacy of antibiotic regimen duration in adolescents and children.

This study, covering the period from January 1, 2017, to December 31, 2020, focused on children under 18 with acute sinusitis treated with either a 5-7 or a 10-day course of Amoxicillin or Amoxicillin-Clavulanate. The study utilized the MarketScan Commercial Claims and Encounters database, which comprised medical and drug data sourced from employers and health plans.

An evaluation of treatment failure, encompassing emergency department or inpatient visits for acute sinusitis, as well as inpatient complications within the initial 5, 10, and 30 days following entry into the cohort was done. Adverse and control outcomes were noted. For confounding control, cox proportional hazards regression using propensity score overlap weights were utilized.

Out of a total of 254,629 patients included in the cohort:

• 19,627 patients were prescribed therapy for 5-7 days (exposure)
• 235,002 patients were prescribed therapy for 10 days (referent)

Following propensity score overlap weighting, the groups demonstrated harmony across all estimated covariates (patient and treatment characteristics). The rate of 30-day therapeutic failure among those dispensed 5-7 days of therapy and among those dispensed 10 days of therapy (hazard ratio 1.12 [95% CI, 1.03,1.21]) is shown below (Table 1):

Adverse events were infrequent, and no difference in negative control outcomes was perceived in either of the groups.

There was a very low overall risk of treatment failure. Children and adolescents receiving a 5-7 days antibiotic course showed a slightly higher treatment failure rate than 10-day therapy. Adverse effects were uncommon, and there was a potential lower occurrence of yeast infections after the shorter therapy.

Considering the marginal benefits and the elevated risk of deleterious effects with longer therapy, opting for a 5-7 days course for acute bacterial sinusitis may be a feasible initial strategy in certain populations.