Prescribing patterns and clinical perceptions of high-dose co-amoxiclav in upper respiratory tract infections: a nationwide study among otorhinolaryngologists

Background: Upper respiratory tract infections (URTIs) are a leading cause of outpatient visits and antibiotic use across age groups. Amoxicillin–clavulanate (co amoxiclav) is widely prescribed due to its activity against β lactamase–producing pathogens. High dose formulations (1 g) aim to enhance pharmacodynamic target attainment and clinical efficacy, particularly against less susceptible organisms. However, real world data on otorhinolaryngologists’ prescribing practices and perceptions of high dose co amoxiclav are limited. Methods: A descriptive, questionnaire-based survey was conducted among otorhinolaryngologists attending the Annual National Conference of the Association of Otolaryngologists of India. A structured 10 item electronic questionnaire captured prescribing patterns, clinical indications, decision drivers, perceived effectiveness, safety, and patient compliance. Data was analysed using descriptive statistics. Results: A total of 176 otorhinolaryngologists participated. Acute otitis media was the most common indication (52%), followed by acute tonsillitis (25%), sinusitis (16%), and pharyngitis (7%). Overall, 70% of respondents prescribed high dose (1g) co amoxiclav sometimes or often, with 59% using it as first line therapy. Clinical efficacy (52%) and once daily dosing convenience (21%) were the main drivers of use. Prescribing decisions were guided by clinical guidelines in 45% of cases. Satisfaction with outcomes was high (93%). Diarrhoea (66%) and nausea (21%) were the most frequently reported adverse effects. Dosing frequency was considered the key determinant of patient compliance (56%). High dose (1g) co amoxiclav was perceived as more effective than other antibiotics by 77% and safer by 87% of respondents. Conclusion: High dose co amoxiclav (1 g) is widely accepted by otorhinolaryngologists for URTIs, supported by perceived efficacy, convenient dosing, favourable safety, and alignment with antimicrobial stewardship principles.