Impact of shortages of amoxicillin and amoxicillin/clavulanate on the outcome of bacterial sinusitis in adults: a French retrospective, single-centre study

Objectives. Recent shortages of amoxicillin and amoxicillin/clavulanate in France have raised concerns about a possible impact on the management and outcome of acute sinusitis. We therefore assessed the rates of complicated sinusitis occurring during two time periods, one with and one without antibiotic shortages. Methods. We reviewed cases of sinusitis from two periods: December-February 2018-19 and 2019-20 (no antibiotic shortages) and December-February 2021-22 and 2022-23 (shortages of amoxicillin and amoxicillin/clavulanate). We included all patients over 15 years of age who had been treated in the hospital’s ear, nose and throat department of Lariboisiere hospital for sinusitis. The primary outcome was the rate of complicated sinusitis among the total number of cases of sinusitis treated at Lariboisière hospital during the two study periods. Results. One hundred and forty-two patients were treated for sinusitis during the study periods: 60 during the no-shortage period and 82 during the shortage period. The rate of complicated sinusitis was significantly higher during the shortage period (23/82, 28%) than during the no-shortage period (3/60, 5%) (OR 7.32, CI [2.04-40.15], p=0.0003). The use of alternative antibiotics prior to attendance was independently associated with an increased risk of complications (OR 7.88, CI [1.58-77.87], p=0.004). The presence of oral streptococci was also associated with complications, suggesting a correlation between microbial patterns and antibiotic shortages. Conclusions. Shortages of first-line antibiotics for sinusitis was associated with an increased rate of complications, highlighting the need to explore alternative treatments and reinforce public health actions to anticipate shortages.