Can Augmentin (amoxicillin-clavulanate) effectively treat streptococcal pharyngitis?

From the Guidelines

Augmentin (amoxicillin-clavulanate) can be used to effectively treat streptococcal pharyngitis, particularly in cases where penicillin cannot be used or a broader spectrum antibiotic is needed. The dosage for adults is typically 875 mg of Augmentin twice daily or 500 mg three times daily for 10 days, while for children, the dosage is based on weight and should be determined by a healthcare provider 1. According to the Infectious Diseases Society of America, amoxicillin-clavulanic acid is a recommended treatment option for streptococcal pharyngitis, with a dosage of 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days 1.

Key Considerations

• The treatment of streptococcal pharyngitis aims to prevent complications such as acute rheumatic fever and reduce symptom duration.
• Penicillin remains the first-line treatment due to its efficacy, safety, and narrow spectrum, but Augmentin can be used as an alternative in certain cases.
• It is essential to complete the full course of antibiotics, even if symptoms improve before the medication is finished, to ensure eradication of the bacteria.
• Patients should be aware of potential side effects, such as diarrhea, nausea, and rash, and the possibility of interference with oral contraceptives.

Treatment Guidelines

• The American Heart Association recommends penicillin or amoxicillin as the first-line treatment for streptococcal pharyngitis, with alternatives such as narrow-spectrum cephalosporins or clindamycin for patients allergic to penicillin 1.
• The Infectious Diseases Society of America guidelines suggest that amoxicillin-clavulanic acid can be used as an alternative treatment option, particularly in cases where a broader spectrum antibiotic is needed 1.

Patient Education

• Patients should be informed about the importance of completing the full course of antibiotics and the potential side effects of Augmentin.
• They should also be aware of the possibility of interference with oral contraceptives and the need to consult their healthcare provider if symptoms persist or worsen after 48-72 hours of treatment.

From the FDA Drug Label

1 INDICATIONS AND USAGE

Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus species. (α-and β-hemolytic isolates only)

The amoxicillin component of Augmentin can effectively treat streptococcal pharyngitis, but only if the isolate is β-lactamase–negative. However, the provided label is for amoxicillin, not Augmentin (amoxicillin-clavulanate). Since the label provided is for amoxicillin (PO) 2, it does not directly answer the question about Augmentin (amoxicillin-clavulanate). Therefore, based on the provided information:

• Key points:
  • The label is for amoxicillin, not Augmentin.
  • Amoxicillin can treat streptococcal pharyngitis if the isolate is β-lactamase–negative.
• Clinical decision: The FDA drug label does not answer the question about Augmentin.

From the Research

Effectiveness of Augmentin in Treating Streptococcal Pharyngitis

• The provided studies do not directly address the effectiveness of Augmentin (amoxicillin-clavulanate) in treating streptococcal pharyngitis 3, 4, 5, 6, 7.
• However, amoxicillin is mentioned as an effective treatment for streptococcal pharyngitis, with a similar efficacy to penicillin 3, 4.
• One study compared azithromycin with amoxicillin in children and found no significant difference in symptom resolution between the two groups 6, 7.
• Another study discussed the use of amoxicillin-clavulanate in the treatment of community-acquired respiratory tract infections, including its effectiveness against beta-lactamase-producing pathogens 5.
• The studies suggest that penicillin is still considered a first-choice treatment for streptococcal pharyngitis due to its low cost and lack of resistance 3, 4, 6, 7.

Comparison of Antibiotics for Streptococcal Pharyngitis

• The studies compared the effectiveness of different antibiotics, including cephalosporins, macrolides, and carbacephem, with penicillin 6, 7.
• The results showed that cephalosporins may be more effective than penicillin in reducing clinical relapse, but the evidence is of low certainty 6, 7.
• Macrolides and penicillin were found to have similar effectiveness in resolving symptoms and preventing clinical relapse 6, 7.
• Carbacephem was found to be more effective than penicillin in resolving symptoms, but the evidence is of low certainty 6, 7.

Limitations of the Studies

• The studies had limitations, including poor reporting of randomization, allocation concealment, and blinding 6, 7.
• The evidence was downgraded due to heterogeneity, wide confidence intervals, and lack of reporting of randomization or blinding 6, 7.
• The studies were conducted in high-income countries with a low risk of streptococcal complications, and there is a need for trials in low-income countries and Aboriginal communities 6, 7.