What is an intravenous (IV) alternative to Augmentin (amoxicillin/clavulanate)?

Intravenous Alternatives to Augmentin (Amoxicillin/Clavulanate)

Ampicillin/sulbactam is the most appropriate intravenous alternative to Augmentin (amoxicillin/clavulanate) with a similar spectrum of activity and clinical efficacy. 1

Primary IV Alternatives to Augmentin

First-Line Options:

1. Ampicillin/sulbactam (Unasyn)

   • Dosing: 1.5-3g IV every 6 hours (1-2g ampicillin + 0.5-1g sulbactam) 1
   • Spectrum: Similar to amoxicillin/clavulanate with gram-positive, gram-negative, and anaerobic coverage
   • WHO classification: Access category (preferred use) 2

2. Piperacillin/tazobactam

   • Dosing: 3.375-4.5g IV every 6-8 hours 3
   • Broader spectrum than Augmentin with enhanced gram-negative coverage
   • WHO classification: Watch category (use with caution) 2

Alternative Options:

• Ceftriaxone + metronidazole (for mixed infections requiring anaerobic coverage) 2, 4
• Ertapenem (1g IV daily) - reserve for more resistant infections 2

Clinical Decision Algorithm

When selecting an IV alternative to Augmentin, consider:

1. Infection type and severity:

   • For mild-moderate infections: Ampicillin/sulbactam
   • For severe infections or suspected resistant pathogens: Piperacillin/tazobactam

2. Suspected pathogens:

   • Community-acquired pneumonia: Ampicillin/sulbactam or ceftriaxone + macrolide 2
   • Intra-abdominal infections: Ampicillin/sulbactam or piperacillin/tazobactam 2
   • Skin/soft tissue infections: Ampicillin/sulbactam 2

3. Patient factors:

   • Renal impairment: Adjust dosing of ampicillin/sulbactam based on creatinine clearance 1
   • Risk of MRSA: Consider adding vancomycin 4
   • Risk of Pseudomonas: Consider piperacillin/tazobactam 2

Special Considerations

• Penicillin allergy: For patients with non-severe penicillin allergy, ceftriaxone may be used. For severe allergies, consider fluoroquinolones (e.g., levofloxacin, moxifloxacin) or other non-beta-lactam alternatives 2

• Pediatric patients: Ampicillin/sulbactam is approved for children ≥1 year at 300 mg/kg/day divided every 6 hours (200 mg ampicillin + 100 mg sulbactam per kg per day) 1

• Renal dosing adjustments for ampicillin/sulbactam: 1

  • CrCl ≥30 mL/min: 1.5-3g q6-8h
  • CrCl 15-29 mL/min: 1.5-3g q12h
  • CrCl 5-14 mL/min: 1.5-3g q24h

Important Caveats

• Avoid unnecessary combination therapy with antibiotics from the same class as this increases adverse effects without providing additional benefit 4

• When administering ampicillin/sulbactam with aminoglycosides, administer separately due to potential inactivation 1, 3

• Duration of therapy should generally not exceed 7-14 days for most infections, with shorter durations (3-5 days) appropriate for many uncomplicated infections with adequate source control 2