From the Guidelines
Augmentin should not be used as a first-line treatment for urinary tract infections (UTIs) due to its inferior efficacy and higher propensity for adverse effects compared to other recommended agents. According to the 2010 update by the Infectious Diseases Society of America and the European Society for Microology and Infectious Diseases 1, beta-lactam agents, including amoxicillin-clavulanate (Augmentin), are appropriate choices for therapy when other recommended agents cannot be used, but they generally have inferior efficacy and more adverse effects compared to other UTI antimicrobials.
Some key points to consider when treating UTIs include:
- Nitrofurantoin monohydrate/macrocrystals and trimethoprim-sulfamethoxazole are recommended as first-line treatments due to their efficacy and minimal resistance 1
- Fosfomycin trometamol and pivmecillinam are also appropriate choices for therapy in certain regions, but may have inferior efficacy compared to standard short-course regimens 1
- Fluoroquinolones, such as ofloxacin, ciprofloxacin, and levofloxacin, are highly efficacious but should be reserved for important uses other than acute cystitis due to their propensity for collateral damage 1
If Augmentin is prescribed for a UTI, the typical adult dose is Augmentin 875/125 mg taken twice daily for 5-7 days, or Augmentin 500/125 mg three times daily for the same duration. It is essential to complete the entire prescribed course, even if symptoms improve before finishing, and to drink plenty of water during treatment to help flush bacteria from the urinary tract. However, it is crucial to note that Augmentin should not be used for empirical treatment of UTIs due to its relatively poor efficacy and high prevalence of antimicrobial resistance 1.
From the FDA Drug Label
- Clinical Studies 14. 1 Lower Respiratory Tract and Complicated Urinary Tract Infections Data from 2 pivotal trials in 1,191 patients treated for either lower respiratory tract infections or complicated urinary tract infections compared a regimen of 875 mg/125 mg amoxicillin and clavulanate potassium tablets every 12 hours to 500 mg/125 mg amoxicillin and clavulanate potassium tablets dosed every 8 hours (584 and 607 patients, respectively). In one of these pivotal trials, patients with either pyelonephritis (n = 361) or a complicated urinary tract infection (i.e., patients with abnormalities of the urinary tract that predispose to relapse of bacteriuria following eradication, n = 268) were randomized (1:1) to receive either 875 mg/125 mg amoxicillin and clavulanate potassium tablets every 12 hours (n = 308) or 500 mg/125 mg amoxicillin and clavulanate potassium tablets every 8 hours (n = 321) The bacteriologic efficacy rates were comparable at one of the follow-up visits (5 to 9 days post-therapy) and at a late post-therapy visit (in the majority of cases, this was 2 to 4 weeks post-therapy), as seen in Table 7
Augmentin (amoxicillin-clavulanate) is effective for the treatment of complicated urinary tract infections, including pyelonephritis.
- The bacteriologic efficacy rates were comparable for the two dosing regimens (875 mg/125 mg every 12 hours and 500 mg/125 mg every 8 hours) at follow-up visits. 2
From the Research
Augmentin for UTI Treatment
- Augmentin, a combination of amoxicillin and clavulanic acid, is a potential treatment option for urinary tract infections (UTIs) caused by certain bacteria 3.
- The combination of amoxicillin and clavulanic acid in Augmentin reduces the level of resistance in most Gram-negative urinary pathogens, making them sensitive to urinary levels of amoxycillin achieved on standard dosage 3.
- Clinical trials have shown a success rate of about 70% for amoxycillin-resistant organisms when treated with Augmentin 3.
Effectiveness and Resistance
- Augmentin has been shown to be effective in treating UTIs, with a low failure rate of 12% compared to other treatments 4.
- However, the effectiveness of Augmentin may be limited by the development of antibiotic resistance, particularly in areas with high rates of resistance 5, 6.
- Amoxicillin-clavulanate, the active ingredients in Augmentin, has been found to have comparatively lower resistance rates compared to other oral antibiotics 6.
Treatment Guidelines
- The Infectious Disease Society of America (IDSA) guidelines recommend nitrofurantoin, fosfomycin, and pivmecillinam as first-line treatments for acute uncomplicated bacterial cystitis 5.
- Augmentin is not listed as a first-line treatment, but may be considered as a second-line option for UTIs caused by certain bacteria, particularly in areas with high rates of resistance 5, 6.
- The choice of antibiotic treatment should be tailored to local resistance patterns and the specific needs of the patient 5, 6.