What alternative antibiotic to prescribe for a patient with an allergy to Augmentin (amoxicillin-clavulanate)?

From the Guidelines

For a patient with an allergy to Augmentin (amoxicillin-clavulanate), cefdinir is a suitable alternative antibiotic, given its low risk of cross-reactivity with penicillin allergy, as evidenced by recent data suggesting that cross-reactivity among penicillins and cephalosporins is lower than historically reported 1.

Key Considerations

• The choice of alternative antibiotic depends on the type of infection being treated and the severity of the patient's allergy to Augmentin.
• Cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1.
• For patients with a history of penicillin allergy, the risk of cross-reactivity with cephalosporins is higher with first-generation cephalosporins but negligible with second- and third-generation cephalosporins 1.

Alternative Antibiotic Options

• Cefdinir (14 mg/kg per day in 1 or 2 doses) is a recommended alternative treatment for patients with penicillin allergy 1.
• Cefuroxime (30 mg/kg per day in 2 divided doses) is another option for patients with penicillin allergy 1.
• Ceftriaxone (50 mg IM or IV per day for 1 or 3 d) may also be considered for patients with penicillin allergy 1.

Important Notes

• It is essential to determine if the patient has a true penicillin allergy, as this will guide the choice of alternative antibiotic.
• If the allergy involves anaphylaxis or severe skin reactions, it is best to avoid all beta-lactam antibiotics.
• Local resistance patterns, patient factors like age and kidney function, and the severity of the infection should also be considered when selecting an alternative antibiotic.

From the FDA Drug Label

WARNINGS Hypersensitivity Reactions Before therapy with ceftriaxone for injection is instituted, careful inquiry should be made to determine whether the patient has had previous hypersensitivity reactions to cephalosporins, penicillins and other beta-lactam agents or other drugs. This product should be given cautiously to penicillin and other beta-lactam agent-sensitive patients

The patient's allergy to Augmentin (amoxicillin-clavulanate), a beta-lactam agent, may pose a risk for a hypersensitivity reaction to ceftriaxone.

• Ceftriaxone is not a suitable alternative for a patient with an allergy to Augmentin due to the risk of cross-reactivity between beta-lactam agents.
• No conclusion can be drawn from this label regarding a safe alternative antibiotic for this patient 2.

From the Research

Alternative Antibiotics to Augmentin

For patients with an allergy to Augmentin (amoxicillin-clavulanate), several alternative antibiotics can be considered. The choice of alternative antibiotic depends on the type of infection being treated and the patient's medical history.

• Levofloxacin: A fluoroquinolone antibiotic that has been shown to be effective in treating a range of infections, including respiratory tract infections, skin and soft tissue infections, and urinary tract infections 3, 4.
• Cefdinir: A cephalosporin antibiotic that has been shown to be effective in treating acute rhinosinusitis and other respiratory tract infections 5.
• Azithromycin: A macrolide antibiotic that has been shown to be effective in treating lower respiratory tract infections, including acute exacerbations of chronic bronchitis and pneumonia 6.

Considerations for Alternative Antibiotics

When choosing an alternative antibiotic to Augmentin, several factors should be considered, including:

• The type of infection being treated
• The patient's medical history, including any allergies or previous reactions to antibiotics
• The potential for antibiotic resistance
• The effectiveness of the alternative antibiotic in treating the specific infection

Efficacy of Alternative Antibiotics

Studies have shown that levofloxacin, cefdinir, and azithromycin are effective in treating a range of infections, including:

• Respiratory tract infections: levofloxacin 3, 4, cefdinir 5, and azithromycin 6
• Skin and soft tissue infections: levofloxacin 3, 4
• Urinary tract infections: levofloxacin 3, 4

It is essential to consult with a healthcare professional to determine the best course of treatment for a patient with an allergy to Augmentin.