From the Guidelines
Clindamycin is generally preferred over Augmentin (amoxicillin-clavulanate) for infections caused by anaerobic bacteria, certain skin and soft tissue infections, and in patients with penicillin allergies, as it is effective against Gram-positive cocci, including methicillin-resistant Staphylococcus aureus, and anaerobes 1.
Key Considerations
- Clindamycin is typically dosed at 300-450 mg orally every 6-8 hours for 7-10 days, depending on the severity and type of infection.
- Augmentin is preferred for broader-spectrum coverage, including many respiratory tract infections, sinusitis, and some skin and soft tissue infections, with a typical adult dose of 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for 7-10 days.
- The choice between these antibiotics should be based on the suspected pathogens, local resistance patterns, patient allergies, and the site of infection, considering the potential for side effects and drug interactions 1.
Specific Indications
- Clindamycin is often used for dental infections, bone and joint infections, and as an alternative for skin and soft tissue infections when beta-lactams can't be used.
- Augmentin provides coverage against both Gram-positive and Gram-negative bacteria, including some beta-lactamase producing strains, and is commonly used for upper and lower respiratory tract infections, urinary tract infections, and skin and soft tissue infections.
Important Considerations
- For patients with penicillin allergies, clindamycin is often the preferred choice as it's structurally unrelated to penicillins, but it carries a higher risk of Clostridioides difficile infection, so it should be used judiciously 1.
- Local resistance patterns and patient-specific factors, such as allergies and comorbidities, should guide the selection of antibiotics to ensure effective treatment and minimize adverse outcomes 1.
From the Research
Preference for Clindamycin over Augmentin
- Clindamycin is preferred over Augmentin (amoxicillin-clavulanate) in the treatment of severe abdominal and female pelvic infections, particularly those involving anaerobic bacteria 2.
- Clindamycin has been shown to be effective in the treatment of obstetric and gynecologic infections, including pelvic inflammatory disease, post-cesarean section endometritis, and posthysterectomy vaginal cuff infections 3.
- Clindamycin is also preferred in the treatment of anaerobic infections, especially when Bacteroides fragilis is not a common isolate, and when high-dose penicillin G therapy is not sufficient 4.
Preference for Augmentin over Clindamycin
- There is no direct evidence in the provided studies to suggest a preference for Augmentin (amoxicillin-clavulanate) over clindamycin in the treatment of specific infections.
- However, it can be inferred that Augmentin may be preferred in cases where aerobic gram-negative bacilli are present, as clindamycin is often used in combination with other antibiotics active against these organisms 5.
- Additionally, metronidazole, which is often used in combination with Augmentin, has been shown to be as effective as clindamycin in the treatment of anaerobic infections, suggesting that Augmentin may be a viable alternative in certain cases 6.