From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For pneumonia not responding to amoxicillin, the recommended treatment typically involves switching to a broader-spectrum antibiotic such as amoxicillin/clavulinic acid (875/125 mg twice daily for 7-10 days) or a respiratory fluoroquinolone like levofloxacin (750 mg once daily for 5 days). In more severe cases, combination therapy with a beta-lactam plus a macrolide or a respiratory fluoroquinolone may be necessary. Hospitalization should be considered if the patient shows signs of respiratory distress, hypoxemia, or significant comorbidities. Treatment failure with amoxicillin often occurs because the infection may be caused by atypical pathogens like Mycoplasma pneumoniae or Legionella, or drug-resistant Streptococcus pneumoniae, which aren't adequately covered by amoxicillin alone 1. It's essential to reassess the patient within 48-72 hours of the new treatment to ensure clinical improvement. If symptoms persist despite the second-line antibiotics, further investigation with chest imaging, sputum cultures, or bronchoscopy may be needed to rule out complications or alternative diagnoses such as tuberculosis, fungal infections, or non-infectious causes. The use of amoxicillin/clavulinic acid is supported by studies showing its efficacy in treating community-acquired respiratory tract infections, including pneumonia 2, 3. However, the most recent and highest quality study suggests that the optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia are unclear, but lower-dose amoxicillin may be noninferior to higher dose, and 3-day treatment may be noninferior to 7 days 4. In adults, the recommended dose of amoxicillin/clavulinic acid for pneumonia not responding to amoxicillin is typically 875/125 mg twice daily for 7-10 days, as this dose provides adequate coverage for most common pathogens, including Streptococcus pneumoniae and Haemophilus influenzae 2, 5. Key considerations in choosing the appropriate antibiotic regimen include the severity of the infection, the presence of comorbidities, and the potential for antibiotic resistance. Some key points to consider when treating pneumonia not responding to amoxicillin include:
- The importance of reassessing the patient within 48-72 hours of the new treatment to ensure clinical improvement
- The need for further investigation with chest imaging, sputum cultures, or bronchoscopy if symptoms persist despite second-line antibiotics
- The potential for antibiotic resistance and the need to choose an antibiotic regimen that provides adequate coverage for common pathogens
- The importance of considering the severity of the infection and the presence of comorbidities when choosing an antibiotic regimen.