From the Guidelines
For pneumonia treatment, when Augmentin (amoxicillin-clavulanate) needs additional coverage, a macrolide such as azithromycin 500mg on day 1 followed by 250mg daily for 4 more days is a common addition, as it provides coverage against atypical pathogens like Mycoplasma pneumoniae and Legionella that Augmentin alone doesn't adequately treat 1. This combination is recommended because it addresses the polymicrobial nature of many pneumonia cases and helps overcome potential resistance mechanisms.
- The choice of additional coverage depends on the severity of the pneumonia and the presence of risk factors for certain pathogens.
- For patients without risk factors for P. aeruginosa, a non-antipseudomonal cephalosporin III + macrolide or moxifloxacin or levofloxacin ± non-antipseudomonal cephalosporin III can be used 1.
- In patients with risk factors for P. aeruginosa, an antipseudomonal cephalosporin or acylureidopenicillin/b-lactamase inhibitor or carbapenem (meropenem preferred) plus ciprofloxacin or a macrolide + aminoglycoside can be used 1.
- It's essential to note that the incidence of CAP through P. aeruginosa seems to be low, and in patients with risk factors for P. aeruginosa, meropenem offers advantages over imipenem because of the option to increase the dose significantly 1.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, stay hydrated, and seek immediate medical attention if breathing difficulties worsen or high fever persists.
- The combination therapy approach is supported by studies that show improved outcomes with the use of macrolides in combination with beta-lactam agents for the treatment of community-acquired pneumonia 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Addition to Augmentin for Pneumonia Treatment
- The use of Augmentin (amoxicillin/clavulanate) in combination with other antibiotics for the treatment of community-acquired pneumonia has been studied in several trials 2, 3, 4, 5.
- A study published in 2007 compared the efficacy of levofloxacin and amoxicillin/clavulanate plus clarithromycin in hospitalized patients with community-acquired pneumonia, and found that levofloxacin was at least as effective as the combination therapy in clinical and microbiological responses 2.
- Another study published in 2004 reviewed the use of amoxicillin/clavulanate in the treatment of community-acquired respiratory tract infections, including pneumonia, and found that it was a broad-spectrum antibacterial with a high bacteriological and clinical efficacy 3.
- A study published in 2003 compared the safety and efficacy of clarithromycin and amoxicillin/clavulanic acid in patients with community-acquired pneumonia, and found that both treatments had similar clinical cure rates and were well tolerated 4.
- A study published in 1994 compared the efficacy of penicillin plus ofloxacin and amoxicillin-clavulanate plus erythromycin in the treatment of severe community-acquired pneumonia, and found that both combinations were effective and safe 5.
- A review published in 2015 discussed the combination effect of macrolide antibiotics in community-acquired pneumonia, and found that combination therapy with a β-lactam and a macrolide may improve survival rates in patients with severe CAP 6.
Potential Additions to Augmentin
- Macrolides, such as clarithromycin, may be added to Augmentin for the treatment of community-acquired pneumonia, especially in cases where atypical organisms are suspected 4, 6.
- Fluoroquinolones, such as levofloxacin, may also be added to Augmentin, especially in cases where Gram-negative pathogens are suspected 2.
- However, the choice of addition to Augmentin should be based on the specific clinical scenario and the suspected or confirmed pathogen 2, 3, 4, 5.