What is the best antibiotic to cover both throat and chest infections?

From the Guidelines

Amoxicillin-clavulanate (Augmentin) is the best antibiotic choice for covering both throat and chest infections, as it provides effective coverage against common respiratory pathogens, including Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae. For adults, a typical regimen is 875mg/125mg twice daily for 7-10 days, while children receive weight-based dosing 1. This medication works well because it combines amoxicillin with clavulanic acid, which helps overcome bacterial resistance by inhibiting beta-lactamase enzymes.

Some key points to consider when prescribing antibiotics for throat and chest infections include:

• The importance of completing the full course of antibiotics, even if symptoms improve quickly
• Staying hydrated, resting adequately, and seeking medical attention if symptoms worsen, high fever develops, or breathing difficulties occur
• The need for proper diagnosis by a healthcare provider before starting treatment, as viral infections, which cause many respiratory illnesses, won't respond to antibiotics
• Considering alternative antibiotics, such as azithromycin, for patients with penicillin allergies

It's also important to note that the choice of antibiotic should be based on effective treatment of the most commonly reported bacterial pathogens, and may include an aminopenicillin with clavulanic acid, a macrolide, or a tetracycline 1. Additionally, the duration of antibiotic treatment should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation 1.

In terms of specific dosing regimens, a study published in 2019 recommended the following:

• Amoxicillin 500 mg three times a day for 14 days for Streptococcus pneumoniae and Haemophilus influenzae infections
• Amoxicillin with clavulanic acid 625 mg three times a day for 14 days for Moraxella catarrhalis infections 1

Overall, amoxicillin-clavulanate is a effective and safe choice for treating throat and chest infections, and should be prescribed for 7-10 days, with the option to extend treatment based on clinical stability.

From the FDA Drug Label

Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS)

Approximately 1% of azithromycin-susceptible S pyogenes isolates were resistant to azithromycin following therapy.

For the 304 patients analyzed in the modified intent to treat analysis at the Day 21 to 24 visit, the clinical cure rate for 3 days of azithromycin was 85% (125/147) compared to 82% (129/157) for 10 days of clarithromycin

The primary endpoint of this trial was the clinical cure rate at Day 21 to 24

For the 594 patients analyzed in the modified intent to treat analysis at the Day 10 visit, the clinical cure rate for 3 days of azithromycin was 88% (268/303) compared to 85% (248/291) for 10 days of amoxicillin/clavulanate.

The best antibiotic to cover both throat and chest infections is azithromycin.

• Key points:
  • Azithromycin has been shown to be effective in treating pharyngitis/tonsillitis and acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD)
  • Azithromycin has a high clinical cure rate for these conditions, with a cure rate of 85% for COPD and 88% for acute bacterial sinusitis
  • The most common side effects of azithromycin are gastrointestinal, including diarrhea, nausea, and abdominal pain 2

From the Research

Antibiotic Options for Throat and Chest Infections

The choice of antibiotic for throat and chest infections depends on the causative pathogen and its susceptibility to various antibiotics.

• Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been used for over 20 years to treat community-acquired respiratory tract infections, including throat and chest infections 3.
• It has a potent broad spectrum of antibacterial activity, coverage of beta-lactamase-producing pathogens, and a favorable pharmacokinetic/pharmacodynamic profile.
• Telithromycin has also been shown to be highly active against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are common causes of respiratory tract infections 4.

Efficacy of Amoxicillin and Amoxicillin-Clavulanate

• Amoxicillin and amoxicillin-clavulanate have been evaluated for antimicrobial postexposure prophylaxis following Bacillus anthracis inhalational exposure in cynomolgus macaques, and both were found to be efficacious 5.
• A pharmacokinetically enhanced formulation of amoxicillin-clavulanate has been developed to provide coverage of bacterial strains with elevated amoxicillin MICs, including Streptococcus pneumoniae and Haemophilus influenzae 6.
• HMR 3647 has also been shown to have good activity against respiratory tract pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 7.

Key Points to Consider

• The choice of antibiotic should be based on the suspected or confirmed causative pathogen and its susceptibility to various antibiotics.
• Amoxicillin/clavulanate is a broad-spectrum antibacterial that can be used to treat a variety of respiratory tract infections, including throat and chest infections.
• Telithromycin and HMR 3647 are also effective against common causes of respiratory tract infections, but their use may be limited by resistance patterns and other factors.