From the Guidelines
No, a person with a hypersensitivity to penicillins should not receive Augmentin (amoxicillin-clavulanate) due to the risk of an allergic reaction. Augmentin contains amoxicillin, which is a penicillin-class antibiotic, and could trigger an allergic reaction in someone with a penicillin allergy, ranging from mild rashes to severe, life-threatening anaphylaxis 1. If you have a documented penicillin allergy, you should inform all healthcare providers about this allergy before receiving any antibiotics.
Alternative Antibiotics
Alternative non-penicillin antibiotics that might be prescribed instead include:
- Macrolides (like azithromycin)
- Tetracyclines (like doxycycline)
- Fluoroquinolones (like ciprofloxacin or levofloxacin)
- Cephalosporins (though some people with penicillin allergies may also react to cephalosporins) 1. The specific alternative will depend on the type of infection being treated and your medical history.
Allergy Testing
If you're unsure about your penicillin allergy status, allergy testing can sometimes determine if you've outgrown the allergy, as many people who report penicillin allergies are no longer allergic when tested 1. This is particularly important, as many people who report penicillin allergies are no longer allergic when tested, and penicillin skin testing in advance of need does not cause significant resensitization 1.
Medical History and Infection Type
It's essential to consider your medical history and the type of infection being treated when choosing an alternative antibiotic. For example, for penicillin-allergic patients with acute bacterial rhinosinusitis, either doxycycline or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended as an alternative agent for empiric antimicrobial therapy 1.
From the FDA Drug Label
Amoxicillin is contraindicated in patients who have experienced a serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin or to other β-lactam antibacterial drugs (e.g., penicillins and cephalosporins).
A person with a hypersensitivity to penicillins should not receive Augmentin (amoxicillin-clavulanate) due to the risk of a serious hypersensitivity reaction.
- Key points:
- Hypersensitivity to penicillins is a contraindication for amoxicillin
- Amoxicillin is a component of Augmentin (amoxicillin-clavulanate)
- Serious hypersensitivity reactions can be fatal 2
From the Research
Hypersensitivity to Penicillins and Augmentin
- A person with a hypersensitivity to penicillins should not receive Augmentin (amoxicillin-clavulanate) if they have a history of hives or anaphylactic reactions to penicillins 3.
- However, if the patient has a low-risk allergy history, such as isolated nonallergic symptoms or a family history of penicillin allergy, they may be able to tolerate Augmentin 4.
- The risk of cross-reactivity between penicillins and other beta-lactam antibiotics, such as cephalosporins, is lower than previously thought, but it is still important to exercise caution when prescribing these antibiotics to patients with a history of penicillin hypersensitivity 5.
Evaluation and Management of Penicillin Allergy
- Patients with a history of penicillin allergy should be evaluated to determine the severity of their allergy and the risk of an allergic reaction to Augmentin 4.
- Penicillin skin testing and graded challenge can be used to diagnose penicillin allergy and determine the safety of using Augmentin 6.
- For patients with a low-risk allergy history, an oral amoxicillin challenge without prior skin testing may be a safe and feasible option for determining tolerance to Augmentin 7.
Considerations for Antimicrobial Therapy
- Clinicians should consider antimicrobial therapy with an antibiotic that does not cross-react with penicillins or beta-lactams for patients with a history of penicillin hypersensitivity 3.
- The use of broad-spectrum antibiotics should be avoided whenever possible, as they can increase the risk of antimicrobial resistance and adverse events 4.