Managing a Culture Showing Microbe Most Sensitive to Augmentin
When a culture shows a microbe most sensitive to Augmentin (amoxicillin/clavulanate), you should prescribe Augmentin at the appropriate dose for the specific infection site and patient characteristics.
Dosing Recommendations Based on Infection Type
For Adults:
Mild to moderate infections with no recent antibiotic use:
Moderate infections or recent antibiotic use (within 4-6 weeks):
- High-dose amoxicillin/clavulanate 2000/125 mg (Augmentin XR) twice daily 3
For Children:
Mild to moderate infections:
- Amoxicillin/clavulanate 45 mg/kg/day divided twice daily 1
Severe infections or recent antibiotic use:
- High-dose amoxicillin/clavulanate 90/6.4 mg/kg/day divided twice daily (Augmentin ES-600) 3
Duration of Therapy
- Respiratory tract infections: 7-10 days 2
- Intra-abdominal infections:
- 4 days for immunocompetent, non-critically ill patients with adequate source control
- Up to 7 days for immunocompromised or critically ill patients 2
- Skin and soft tissue infections: 7-10 days, may be longer for complex infections 4
Special Considerations
Monitoring Response
- Evaluate clinical response after 72 hours of therapy
- If no improvement or worsening occurs, consider:
- Reevaluating the patient for complications or alternative diagnoses
- Switching to an alternative antibiotic based on culture results 2
Common Side Effects and Management
- Gastrointestinal effects (diarrhea, nausea): Take with food
- Consider probiotics to reduce risk of antibiotic-associated diarrhea
- Monitor for signs of C. difficile infection, especially with prolonged therapy 2
Resistance Concerns
- Augmentin has maintained good efficacy against many common pathogens despite decades of use 3
- The combination of amoxicillin with clavulanate effectively extends the spectrum to include beta-lactamase-producing organisms 1
- In areas with high prevalence of resistant S. pneumoniae, higher doses may be required 3
Clinical Pearls
- Augmentin is particularly effective against beta-lactamase-producing organisms like H. influenzae and M. catarrhalis, as well as many strains of S. pneumoniae 1, 3
- For severe infections requiring IV therapy initially, consider transitioning to oral Augmentin when clinically improved for outpatient completion of therapy 2
- In complicated intra-abdominal infections, Augmentin is an appropriate choice for mild cases with adequate source control 2
- For recurrent or persistent infections, consider whether there are anatomical factors, foreign bodies, or immunocompromise contributing to treatment failure
Remember that while culture results guide therapy, clinical response remains the ultimate measure of treatment success. Adjust therapy based on patient response, not just laboratory findings.