Which is a broader antibiotic, cefuroxime or Augmentin (amoxicillin-clavulanate)?

From the Guidelines

Augmentin (amoxicillin-clavulanate) has a broader spectrum of activity than cefuroxime, as it combines amoxicillin with clavulanic acid, a beta-lactamase inhibitor that extends its coverage to include many beta-lactamase-producing bacteria, providing good coverage against gram-positive organisms, many gram-negative bacteria, and anaerobes 1.

Key Points

• Augmentin's broader coverage is particularly valuable for mixed infections like sinusitis, otitis media, skin and soft tissue infections, and respiratory tract infections where multiple pathogens may be present.
• Cefuroxime, a second-generation cephalosporin, has good activity against many gram-positive cocci and some gram-negative organisms but has limited activity against anaerobes and certain gram-negative bacteria.
• The choice between these antibiotics should be guided by the suspected pathogens, local resistance patterns, patient allergies, and the specific infection being treated, as recommended by recent guidelines 1.

Considerations

• Augmentin may cause more disruption to normal gut flora, potentially leading to a higher risk of antibiotic-associated diarrhea or Clostridioides difficile infection.
• Recent studies suggest that amoxicillin-clavulanate is a reasonable option for empirical therapy in certain infections, such as diabetes-related foot infections 1.
• Local resistance patterns and patient-specific factors should be taken into account when selecting an antibiotic regimen, as emphasized in recent guidelines 1.

From the Research

Comparison of Antibiotic Spectrum

• Cefuroxime and Augmentin (amoxicillin-clavulanate) are both broad-spectrum antibiotics, but their effectiveness against different types of bacteria varies 2, 3, 4, 5, 6.
• Cefuroxime has a broad spectrum of in vitro antibacterial activity, including methicillin-sensitive staphylococci and common respiratory pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 3, 4.
• Augmentin, a combination of amoxicillin and clavulanic acid, also has a broad spectrum of activity, but its effectiveness against certain bacteria, such as beta-lactamase-producing strains, is enhanced by the presence of clavulanic acid 2, 6.

Efficacy in Clinical Trials

• Clinical trials have shown that cefuroxime axetil is as effective as Augmentin in the treatment of upper respiratory tract infections, such as tonsillitis, pharyngitis, and sinusitis 2.
• Cefuroxime axetil has also been shown to be effective in the treatment of lower respiratory tract infections, including acute bronchitis and community-acquired pneumonia 3, 5.
• Augmentin has also been shown to be effective in the treatment of various infections, including urinary tract infections and skin infections 6.

Spectrum of Activity

• Cefuroxime has a broader spectrum of activity against Gram-positive bacteria, including methicillin-sensitive staphylococci and Streptococcus pneumoniae 3, 4.
• Augmentin has a broader spectrum of activity against Gram-negative bacteria, including beta-lactamase-producing strains of Haemophilus influenzae and Moraxella catarrhalis 2, 6.
• Overall, cefuroxime appears to have a slightly broader spectrum of activity than Augmentin, particularly against Gram-positive bacteria 3, 4, 5.