Can I administer Augmentin (amoxicillin/clavulanate) after azithromycin?

From the Guidelines

It is not recommended to administer Augmentin (amoxicillin/clavulanate) immediately after azithromycin without medical guidance, as this may increase the risk of side effects, antibiotic resistance, and disruption of normal gut flora. The guidelines for antimicrobial treatment of acute bacterial rhinosinusitis suggest that amoxicillin/clavulanate can be used as an initial therapy or as a switch therapy option in cases where there is no improvement or worsening after 72 hours of initial therapy 1. However, the decision to switch to amoxicillin/clavulanate after azithromycin should be based on the patient's clinical presentation, disease severity, and risk factors for infection with resistant organisms.

Some key points to consider when deciding whether to administer amoxicillin/clavulanate after azithromycin include:

• The patient's symptoms and disease severity, as mild disease may require a different approach than moderate or severe disease
• The patient's history of recent antimicrobial use, as this can increase the risk of infection with resistant organisms
• The local prevalence of penicillin-resistant S pneumoniae or DRSP, as this may affect the choice of antibiotic therapy
• The potential for side effects and interactions between amoxicillin/clavulanate and azithromycin, as both medications can cause digestive side effects and may worsen each other's adverse effects.

According to the guidelines, amoxicillin/clavulanate can be used as a switch therapy option in cases where there is no improvement or worsening after 72 hours of initial therapy with azithromycin 1. However, the guidelines also emphasize the importance of considering the limitations in coverage of the initial antibiotic and the potential for treatment failure or resistant pathogens when making decisions about antibiotic therapy 1. Therefore, it is essential to consult with a healthcare provider before administering amoxicillin/clavulanate after azithromycin to determine the best course of treatment for the patient's specific condition.

From the FDA Drug Label

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 FDA drug label does not directly answer whether Augmentin (amoxicillin/clavulanate) can be administered after azithromycin. However, it does compare the efficacy of azithromycin and amoxicillin/clavulanate in treating certain infections, suggesting that they can be used as alternative treatments.

• Key points:
  • Azithromycin and amoxicillin/clavulanate have been compared in clinical trials for the treatment of acute bacterial sinusitis.
  • The clinical cure rates for azithromycin and amoxicillin/clavulanate were similar in these trials.
  • There is no direct information on the administration of amoxicillin/clavulanate after azithromycin. 2

From the Research

Administration of Augmentin after Azithromycin

• There is no direct evidence in the provided studies that specifically addresses the administration of Augmentin (amoxicillin/clavulanate) after azithromycin.
• However, studies 3 and 4 compare the efficacy of azithromycin with amoxicillin/clavulanic acid (Augmentin) in treating various infections, suggesting that both antibiotics can be effective in similar contexts.
• Study 3 found that a 3-day regimen of azithromycin was as clinically and microbiologically effective as a 10-day regimen of co-amoxiclav (Augmentin) in the treatment of acute lower respiratory tract infections.
• Study 4 compared azithromycin with amoxicillin/clavulanic acid and cefaclor in the treatment of acute ear, nose, and throat infections, and found that azithromycin had a higher clinical effectiveness and faster improvement compared to the other two treatments.
• While these studies do not directly address the sequential use of azithromycin followed by Augmentin, they suggest that both antibiotics can be used to treat similar types of infections, and that the choice of antibiotic may depend on various factors such as the specific infection, patient population, and treatment duration.
• Studies 5 and 6 discuss the use of azithromycin in combination with other antibiotics, such as ceftriaxone, for the treatment of community-acquired pneumonia, but do not provide information on the use of Augmentin after azithromycin.
• Study 7 compares azithromycin with clarithromycin in the treatment of upper respiratory tract infections, but does not provide relevant information on the use of Augmentin after azithromycin.