Is Augmentin (amoxicillin-clavulanate) effective for treating Urinary Tract Infections (UTI)?

From the Guidelines

Augmentin should not be used as a first-line treatment for uncomplicated 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 Micrology and Infectious Diseases 1, b-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 for uncomplicated cystitis due to their efficacy and minimal resistance 1.
• The choice of antibiotic should be based on local resistance rates and the susceptibility of the infecting strain 1.
• Augmentin may be considered for use in complicated UTIs or when other recommended agents cannot be used, but its use should be cautious due to the potential for adverse effects and inferior efficacy 1.

It is essential to note that the treatment of UTIs should be individualized based on the patient's specific needs and the local epidemiology of antimicrobial resistance. The use of Augmentin for UTIs should be guided by the principles of antimicrobial stewardship, which aim to optimize the use of antibiotics while minimizing the risk of adverse effects and the development of antimicrobial resistance.

From the FDA Drug Label

1. 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 bacteriological success rates were comparable between the two dosing regimens (875 mg/125 mg every 12 hours and 500 mg/125 mg every 8 hours) in patients with complicated urinary tract infections. 2

From the Research

Augmentin for UTI Treatment

• Augmentin, also known as amoxicillin-clavulanate, is a broad-spectrum antibiotic used to treat various bacterial infections, including urinary tract infections (UTIs) 3, 4.
• According to the studies, Augmentin is considered a second-line option for treating UTIs, particularly for infections caused by ESBL-producing Enterobacteriales 3.
• The use of Augmentin for UTI treatment is supported by its pharmacokinetic properties, which allow for effective penetration into the urinary tract 5.
• However, the choice of antibiotic for UTI treatment should be based on local susceptibility patterns and the patient's medical history, including any previous antibiotic use or resistance 3, 4.

Guidelines for UTI Treatment

• The Infectious Diseases Society of America recommends nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin as first-line antibiotic treatments for uncomplicated UTIs 6, 7.
• Augmentin is not typically recommended as a first-line treatment for uncomplicated UTIs, but it may be considered for more complex infections or in cases where first-line treatments are not effective 3, 4.
• The American Family Physician recommends considering the patient's age, medical history, and antibiotic resistance patterns when selecting an antibiotic for UTI treatment 6.

Resistance and Treatment Efficacy

• The increasing prevalence of antibiotic-resistant uropathogens affects the diagnosis and management of UTIs 3, 4.
• The use of Augmentin for UTI treatment may be limited by the presence of resistant bacteria, such as ESBL-producing Enterobacteriales 3.
• The studies emphasize the importance of using antibiotics wisely and reserving broad-spectrum antibiotics, like Augmentin, for more complex infections or cases where first-line treatments are not effective 3, 7.