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She tells you that whenever you treat sinus infections at the urgent care office, they always use amoxicillin plus clavulonate rather than just amoxicillin alone and wonders why you are not doing the same.

Hi, this is Frank Domino, and joining me this morning is Dr. Alan Ehrlich, associate professor in the Department of Family Medicine and Community Health at the UMass Chan Medical School and executive editor of Dynamed.

Good morning, Alan.

Good morning, Frank.

And when it comes to the antibiotics, the guidelines are not very prescriptive when it comes to the recommendations of treatment.

Expert level of opinion, um, and various other resources, things like UpToDate or DynaMed, have categorization, a little bit more of an algorithm that they follow.

The main thing I want you to take away from this is we want to assess their risk for poor outcomes.

So is their FEV1 less than fifty percent? Are they in that Gold 3 category? Do they have two or more exacerbations per year or hospitalizations in the last year? Do they use oxygen or-- and do they have other comorbidities, especially known cardiovascular comorbidities? Those patients are going to be using something like a, um, like an amoxicillin-clavulanate or a fluoroquinolone.