From the Guidelines
Augmentin (amoxicillin-clavulanate) does not effectively cover atypical bacteria, and its use should be supplemented with other antibiotics, such as macrolides or fluoroquinolones, when treating infections where atypical pathogens are suspected. This is because Augmentin primarily targets gram-positive bacteria, many gram-negative bacteria, and anaerobes, but lacks activity against atypical organisms such as Mycoplasia pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila, as evident from the guidelines provided by the Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults 1.
The guidelines recommend the use of macrolides, tetracyclines, or respiratory fluoroquinolones for the treatment of atypical pathogens, and suggest that combination therapy with a beta-lactam antibiotic, such as Augmentin, and a macrolide or fluoroquinolone may be beneficial in certain cases, such as severe community-acquired pneumonia 2.
Key points to consider when using Augmentin include:
- Augmentin's spectrum of activity does not include atypical bacteria
- Atypical bacteria, such as Mycoplasia pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila, require alternative antibiotics, such as macrolides or fluoroquinolones
- Combination therapy with Augmentin and a macrolide or fluoroquinolone may be beneficial in certain cases, such as severe community-acquired pneumonia
- The choice of antibiotic should be guided by the suspected or confirmed pathogen, as well as local resistance patterns and patient-specific factors, as recommended by the guidelines 1, 2.
From the Research
Atypical Bacteria and Augmentin Coverage
- Atypical bacteria, such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella species, do not respond to β-lactam antibiotics like Augmentin (amoxicillin-clavulanate) because they lack a cell wall 3, 4, 5.
- The therapeutic approach for atypical pneumonias is different from that for typical pneumonia, and macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia 3, 4, 5.
- Augmentin is a β-lactam antibiotic and does not cover atypical bacteria, therefore it is not the preferred treatment for atypical pneumonia 3, 4, 5.
- In some cases, a combination of a β-lactam drug with a macrolide or tetracycline may be considered to cover both typical and atypical bacteria 3, 6, 7.
Treatment of Atypical Pneumonia
- Macrolides are the first-line antibiotics used in children with atypical pneumonia because of their low minimum inhibitory concentrations and high safety 4.
- The incidence of pneumonia caused by macrolide-resistant M. pneumoniae has been increasing, and empirical macrolide therapy may not provide additional benefits over β-lactam monotherapy and can increase the risk of resistance 4.
- Quinolones and telithromycin have the highest level of anti-Legionella activity, and therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used 5.
- The addition of a macrolide to ceftaroline fosamil or ceftriaxone treatment in atypical CAP may improve early clinical response rate, but this hypothesis is best evaluated in a prospective trial 6.