What alternative antibiotic can be used if vomiting develops after starting Augmentin (amoxicillin/clavulanate)?

From the Guidelines

If vomiting develops after starting Augmentin, a single 50-mg/kg dose of ceftriaxone, given either intravenously or intramuscularly, can be used as an alternative antibiotic. This recommendation is based on the evidence from the American Academy of Pediatrics guideline for the diagnosis and management of acute bacterial sinusitis in children 1. Ceftriaxone is effective against the major bacterial pathogens involved in acute bacterial sinusitis, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Some key points to consider when switching to ceftriaxone include:

• The dose of ceftriaxone should be 50 mg/kg, given either intravenously or intramuscularly 1.
• If clinical improvement is observed at 24 hours, an oral antibiotic can be substituted to complete the course of therapy 1.
• Ceftriaxone is a good option for children who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic 1.
• The choice of antibiotic should be tailored to the type and severity of infection, local resistance patterns, and patient-specific factors, including allergy history 1.

It's essential to consult with a healthcare provider before switching antibiotics to ensure appropriate treatment of the underlying infection. Additionally, other alternatives like cefdinir, cefuroxime, or cefpodoxime can be considered for patients with hypersensitivity to amoxicillin 1.

From the Research

Alternative Antibiotics

If vomiting develops after starting Augmentin (amoxicillin/clavulanate), alternative antibiotics can be considered. Some options include:

• Azithromycin, as studied in 2, which showed comparable efficacy to amoxicillin/clavulanate in treating lower respiratory tract infections.
• Other antibiotics that are effective against the specific infection being treated, such as those used to treat community-acquired respiratory tract infections, as discussed in 3.

Considerations for Alternative Antibiotics

When selecting an alternative antibiotic, consider the following:

• The type of infection being treated, as different antibiotics have different spectrums of activity.
• The patient's medical history and potential allergies or interactions with other medications.
• The potential side effects of the alternative antibiotic, such as gastrointestinal disturbances, as seen with amoxicillin/clavulanate in 4 and 5.

Efficacy and Safety of Alternative Antibiotics

Studies have shown that alternative antibiotics, such as azithromycin, can be effective and well-tolerated in treating various infections, including:

• Lower respiratory tract infections, as shown in 2.
• Acute otitis media, as discussed in 4 and 5.
• Other infections, such as those caused by Bacillus anthracis, as studied in 6.