{"id":24706,"date":"2023-12-03T04:39:00","date_gmt":"2023-12-02T20:39:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24706"},"modified":"2023-12-03T06:18:40","modified_gmt":"2023-12-02T22:18:40","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%98%bf%e8%8e%ab%e8%a5%bf%e6%9e%97-%e5%85%8b%e6%8b%89%e7%bb%b4%e9%85%b8%e6%88%96%e9%98%bf%e8%8e%ab%e8%a5%bf%e6%9e%97%e6%b2%bb%e7%96%97%e6%80%a5","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24706","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u963f\u83ab\u897f\u6797-\u514b\u62c9\u7ef4\u9178\u6216\u963f\u83ab\u897f\u6797\u6cbb\u7597\u6025\u6027\u9f3b\u7aa6\u708e\u513f\u7ae5\u7684\u6cbb\u7597\u5931\u8d25\u7387\u4e0e\u4e0d\u826f\u4e8b\u4ef6"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

September 19, 2023<\/p>\n\n\n\n

Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis<\/h1>\n\n\n\n

Timothy J.\u00a0Savage,\u00a0Matthew P.\u00a0Kronman,\u00a0Sushama Kattinakere\u00a0Sreedhara,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;330(11):1064-1073. doi:10.1001\/jama.2023.15503<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  For pediatric acute sinusitis, is amoxicillin-clavulanate associated with different rates of treatment failure or adverse events compared with amoxicillin?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 320\u202f141 children, treatment failure was rare (1.7% overall) and serious treatment failure was very rare (0.01%). There was no difference in treatment failure between groups while adverse events, specifically gastrointestinal symptoms and yeast infections, were more frequent among patients treated with amoxicillin-clavulanate.<\/p>\n\n\n\n

Meaning<\/strong>  Among children with acute sinusitis treated in the outpatient setting, amoxicillin-clavulanate was associated with more adverse events and no difference in treatment failure risk compared to amoxicillin.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Acute sinusitis is one of the most common indications for antibiotic prescribing in children, with an estimated 4.9 million such prescriptions in the US annually. Consensus does not exist regarding the optimal empirical antibiotic.<\/p>\n\n\n\n

Objective<\/strong>  To compare amoxicillin-clavulanate vs amoxicillin for the treatment of acute sinusitis in outpatient children.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Cohort study of children and adolescents aged 17 years or younger with a new outpatient diagnosis of acute sinusitis and a same-day new prescription dispensation of amoxicillin-clavulanate or amoxicillin in a nationwide health care utilization database. Propensity score matching was used to mitigate confounding.<\/p>\n\n\n\n

Exposure<\/strong>  A new prescription dispensation of amoxicillin-clavulanate or amoxicillin.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Treatment failure, defined as an aggregate of a new antibiotic dispensation, emergency department or inpatient encounter for acute sinusitis, or inpatient encounter for a sinusitis complication, was assessed 1 to 14 days after cohort enrollment. Adverse events were evaluated, including gastrointestinal symptoms, hypersensitivity and skin reactions, acute kidney injury, and secondary infections.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0The cohort included 320\u202f141 patients. After propensity score matching, there were 198\u202f942 patients (99\u202f471 patients per group), including 100\u202f340 (50.4%) who were female, 101\u202f726 (51.1%) adolescents aged 12 to 17 years, 52\u202f149 (26.2%) children aged 6 to 11 years, and 45\u202f067 (22.7%) children aged 0 to 5 years. Treatment failure occurred in 1.7% overall; 0.01% had serious failure (an emergency department or inpatient encounter). There was no difference in the risk of treatment failure between the amoxicillin-clavulanate and amoxicillin groups (relative risk [RR], 0.98 [95% CI, 0.92-1.05]). The risk of gastrointestinal symptoms (RR, 1.15 [95% CI, 1.05-1.25]) and yeast infections (RR, 1.33 [95% CI, 1.16-1.54]) was higher with amoxicillin-clavulanate. After patients were stratified by age, the risk of treatment failure after amoxicillin-clavulanate was an RR of 0.98 (95% CI, 0.86-1.12) for ages 0 to 5 years; RR was 1.06 (95% CI, 0.92-1.21) for 6 to 11 years; and RR was 0.87 (95% CI, 0.79-0.95) for 12 to 17 years. The age-stratified risk of adverse events after amoxicillin-clavulanate was an RR of 1.23 (95% CI, 1.10-1.37) for ages 0 to 5 years; RR was 1.19 (95% CI, 1.04-1.35) for 6 to 11 years; and RR was 1.04 (95% CI, 0.95-1.14) for 12 to 17 years.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  In children with acute sinusitis who were treated as outpatients, there was no difference in the risk of treatment failure between those who received amoxicillin-clavulanate compared with amoxicillin, but amoxicillin-clavulanate was associated with a higher risk of gastrointestinal symptoms and yeast infections. These findings may help inform decisions for empirical antibiotic selection in acute sinusitis.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  September 19, 20 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24706"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24706"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24706\/revisions"}],"predecessor-version":[{"id":24707,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24706\/revisions\/24707"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24706"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24706"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24706"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}