Will Augmentin (amoxicillin/clavulanate) cover upper and lower respiratory infections?

Augmentin for Upper and Lower Respiratory Infections

Augmentin (amoxicillin-clavulanate) is effective for both upper and lower respiratory tract infections caused by susceptible bacteria, particularly beta-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis. 1

Spectrum of Coverage

Augmentin provides coverage against common respiratory pathogens:

• Lower respiratory tract infections: FDA-approved for infections caused by beta-lactamase-producing strains of H. influenzae and M. catarrhalis 1
• Upper respiratory tract infections: Effective for bacterial sinusitis and acute otitis media caused by beta-lactamase-producing strains of H. influenzae and M. catarrhalis 1
• Streptococcus pneumoniae: Effective against many strains, including some with reduced penicillin susceptibility 2

Appropriate Use Guidelines

The American College of Physicians recommends:

• Amoxicillin-clavulanate as first-line therapy for patients with combined upper and lower respiratory symptoms when bacterial infection is suspected 3
• For adults with suspected bacterial bronchitis/pneumonia, Augmentin is recommended due to its broad spectrum against common respiratory pathogens, including beta-lactamase producers 3

Dosing Recommendations

Adults:

• Mild to moderate infections: 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours 1
• Severe infections and respiratory tract infections: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 1

Children:

• Age ≥3 months: 45 mg/kg/day divided every 12 hours (based on amoxicillin component) for otitis media, sinusitis, and lower respiratory tract infections 1
• Children <3 years with pneumonia: Amoxicillin 80-100 mg/kg/day 3

Important Clinical Considerations

1. Bacterial vs. Viral Etiology:

   • Most upper respiratory infections are viral and don't require antibiotics 3
   • Use Anthonisen criteria for lower respiratory infections (increased dyspnea, increased sputum purulence, increased sputum volume) - presence of at least 2 criteria suggests need for antibiotics 3

2. Treatment Assessment:

   • Evaluate efficacy within 3 days of starting treatment
   • Symptoms should improve within 48-72 hours with effective treatment
   • If no improvement after 72 hours, reassess diagnosis and consider alternative antibiotics 3

3. Duration of Treatment:

   • 7-10 days for most infections
   • 14 days for severe cases 3

Special Considerations

• Beta-lactamase producers: Augmentin is specifically indicated for infections caused by beta-lactamase-producing organisms that would be resistant to amoxicillin alone 1
• Penicillin allergy: Consider macrolides or doxycycline, though macrolides have high resistance rates 3
• Renal impairment: Dose adjustment required for patients with GFR <30 mL/min 1

Common Pitfalls to Avoid

1. Overuse in viral infections: Most upper respiratory infections are viral and don't require antibiotics. Reserve Augmentin for cases with strong evidence of bacterial infection 3

2. Inappropriate dosing: Don't substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amoxicillin-to-clavulanate ratios 1

3. Inadequate duration: Complete the full course (typically 7-10 days) to prevent recurrence and resistance 3

4. Using when not needed: When susceptibility tests show susceptibility to amoxicillin alone (no beta-lactamase production), Augmentin should not be used 1

Augmentin remains a cornerstone antibiotic for respiratory infections due to its broad spectrum, effectiveness against beta-lactamase producers, and favorable pharmacokinetic profile 2.