From the FDA Drug Label
Amoxicillin/clavulanic acid has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections... Gram-Negative Aerobes: Enterobacter species (Although most strains of Enterobacter species are resistant in vitro, clinical efficacy has been demonstrated with Amoxicillin and Clavulanate Potassium in urinary tract infections caused by these organisms.)
The use of Augmentin (amoxicillin/clavulanic acid) is likely due to its broad-spectrum activity against gram-negative bacteria, including Enterobacter species. Although most strains of Enterobacter species are resistant in vitro, clinical efficacy has been demonstrated in urinary tract infections caused by these organisms 1. This suggests that Augmentin may be effective in treating Enterobacter cloacae infections, especially when combined with ciprofloxacin, to which the organism is sensitive.
- Key points:
- Augmentin has broad-spectrum activity against gram-negative bacteria
- Clinical efficacy has been demonstrated in urinary tract infections caused by Enterobacter species
- Combination with ciprofloxacin may enhance effectiveness against Enterobacter cloacae infections 1
From the Research
Augmentin is being recommended alongside ciprofloxacin for your Enterobacter cloacae wound infection due to its ability to provide broader coverage against possible polymicrobial infection, despite potential concerns about Enterobacter's intrinsic resistance to ampicillin. The dual therapy approach with Augmentin and ciprofloxacin is valuable for wound infections where multiple organisms often coexist. While Enterobacter species often carry AmpC beta-lactamases that can inactivate many penicillins, the clavulanic acid component in Augmentin offers some inhibition of these enzymes 2. Key points to consider:
- The clavulanic acid component in Augmentin provides some inhibition of AmpC beta-lactamases, which are often carried by Enterobacter species.
- The combination of Augmentin and ciprofloxacin ensures coverage against gram-positive organisms and anaerobes that might be present but not identified in the culture.
- Ciprofloxacin specifically targets the Enterobacter, while Augmentin addresses other potential pathogens.
- Typical dosing for Augmentin is 875/125 mg twice daily, and for ciprofloxacin, it is 500-750 mg twice daily, with duration typically 7-14 days depending on clinical response and wound healing.
- Regular wound care and monitoring for clinical improvement remain essential alongside antibiotic therapy. It's worth noting that a recent study from 2023 found that high-dose cefepime was not associated with an increased risk of 30-day mortality compared to carbapenem therapy for bacteremia caused by Enterobacterales with moderate to high risk of clinically significant AmpC production 2. However, this does not directly impact the recommendation for Augmentin and ciprofloxacin in this case.