Augmentin for Treating Infections: Indications and Recommendations
Augmentin (amoxicillin/clavulanate) is an appropriate first-line treatment for sinusitis, respiratory tract infections, skin infections, and as a second-line agent for Group A streptococcal pharyngitis carriers, with dosing of 875/125 mg twice daily for adults or 90 mg/6.4 mg/kg/day in two divided doses for children.
Sinusitis Treatment
Augmentin is particularly effective for acute bacterial sinusitis due to its coverage against common pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1.
Recommended dosing for sinusitis:
- Adults: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
- High-dose option: 2000 mg (amoxicillin component) with 125 mg clavulanate twice daily for 5-7 days
The addition of clavulanic acid to amoxicillin provides protection against beta-lactamase-producing organisms, which are common in sinusitis 1. This is particularly important as up to 20-30% of H. influenzae strains are beta-lactamase producers and resistant to penicillins alone 2.
When to use Augmentin for sinusitis:
- Patients with moderate disease
- Recent antimicrobial use (past 4-6 weeks)
- Areas with high prevalence of penicillin-resistant S. pneumoniae
- Patients requiring better H. influenzae coverage
Respiratory Tract Infections
For lower respiratory tract infections, particularly COPD exacerbations, Augmentin is recommended when:
- Beta-lactamase producing organisms are suspected
- Previous antibiotic therapy has failed
- Patients have moderate disease severity
According to European guidelines, amoxicillin-clavulanate should be used in high dosages (875/125 mg) to obtain concentrations in serum and bronchial secretions above the MIC of resistant strains 2. The newer formulation of 2000/125 mg twice daily may be particularly useful for this purpose.
Group A Streptococcal Pharyngitis
While not first-line for acute streptococcal pharyngitis, Augmentin is specifically recommended for chronic carriers of Group A Streptococcus:
- Dosage: 40 mg amoxicillin per kg per day in three doses (maximum = 2,000 mg amoxicillin per day)
- Duration: 10 days
- Recommendation strength: Strong, with moderate quality evidence 2
Intra-abdominal Infections
For intra-abdominal infections, beta-lactam/beta-lactamase inhibitor combinations like Augmentin have activity against gram-positive, gram-negative, and anaerobic organisms 2. While amoxicillin/clavulanate is still an option in mild community-acquired intra-abdominal infections, more severe infections may require broader coverage.
Skin Infections
Research has shown Augmentin to be highly effective (94% response rate) for various skin infections, particularly when mixed infections of penicillin-resistant staphylococci and Streptococcus pyogenes are present 3.
Advantages of Augmentin
- Broad-spectrum coverage: Effective against both gram-positive and gram-negative pathogens
- Beta-lactamase protection: Clavulanic acid inhibits beta-lactamases, preserving amoxicillin's activity
- Low resistance development: Has shown a low propensity to select for resistance mutations 4
- Favorable pharmacokinetic profile: Achieves good tissue penetration
Monitoring and Side Effects
Common side effects include:
- Nausea (9%)
- Diarrhea (9%)
- Rash (3%) 3
Important Clinical Considerations
- Assess for improvement: Evaluate clinical response within 72 hours of starting therapy 1
- Duration: Typically 5-7 days for most respiratory and sinus infections
- Dosing with food: Take with food to minimize GI side effects
- Alternative for penicillin allergy: Not suitable for patients with true penicillin allergy; consider respiratory fluoroquinolones instead
Conclusion
Augmentin remains a valuable antibiotic for various community-acquired infections due to its broad spectrum of activity and protection against beta-lactamase-producing organisms. The high-dose formulations (2000/125 mg for adults and 90/6.4 mg/kg/day for children) are particularly useful for infections caused by resistant pathogens.