Indications for Augmentin (Amoxicillin-Clavulanate) Use
Augmentin (amoxicillin-clavulanate) should be used when treating infections likely caused by beta-lactamase-producing bacteria or when initial amoxicillin therapy has failed. 1, 2
Primary Indications
Urinary Tract Infections
- First-choice option for lower urinary tract infections according to WHO Essential Medicines guidelines 1
- Recommended for urinary tract infections caused by beta-lactamase-producing organisms with a success rate of approximately 70% for amoxicillin-resistant organisms 3
Respiratory Tract Infections
- Indicated for acute bronchiolitis in children with high fever (≥38.5°C) persisting for more than 3 days 1
- Recommended for acute bronchiolitis with associated purulent acute otitis media or pneumonia/atelectasis confirmed by chest X-ray 1
- Appropriate for children under 5 years with pneumonia who have insufficient vaccination against H. influenzae type b (less than three injections) 1
- Indicated for moderate to severe COPD exacerbations without risk factors for Pseudomonas aeruginosa 2
Sinusitis
- Recommended for acute bacterial sinusitis in children, particularly those presenting with moderate to severe illness 1
- High-dose amoxicillin-clavulanate (80-90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate) is indicated for patients younger than 2 years, attending child care, or who have recently been treated with antimicrobials 1
- Indicated for frontal or sphenoidal sinusitis or for patients with comorbid conditions 2
Otitis Media
- Recommended for acute otitis media in children who have received amoxicillin in the previous 30 days or with otitis-conjunctivitis syndrome 2
Specific Clinical Scenarios
When to Choose Augmentin Over Amoxicillin
- When treating infections in communities with high prevalence of beta-lactamase-producing H. influenzae and M. catarrhalis 4
- For patients who have received antibiotics within the previous 30 days 1, 2
- When initial amoxicillin therapy has failed 1
- For children attending daycare (higher risk of resistant organisms) 1
- For children younger than 2 years (higher risk of resistant organisms) 1
Dosing Considerations
- Standard dose: 45 mg/kg/day in 2 divided doses for children with less severe infections 2
- High dose: 80-90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses for more severe infections or when antibiotic resistance is likely 1, 2
- For adults, higher doses (875 mg/125 mg or 2000 mg/125 mg) should be considered when antibiotic resistance is likely 2, 4
Common Pitfalls and Caveats
- Augmentin should not be used as first-line therapy for all infections; amoxicillin alone remains the first choice for uncomplicated infections when beta-lactamase-producing organisms are not suspected 1
- Overuse of Augmentin may contribute to antimicrobial resistance; reserve for appropriate indications 4
- Higher rates of gastrointestinal side effects compared to amoxicillin alone, though generally well-tolerated 3
- Duration of therapy should be tailored to the specific infection: 7-10 days for respiratory infections, 10-14 days for sinusitis, and 3-7 days for uncomplicated UTIs 2
- Clinical response should be evaluated within 48-72 hours of initiating therapy 2
Historical Context
- Augmentin was developed to address the emergence of beta-lactamase-mediated resistance, which rendered penicillins inactive 5
- First launched in the UK in 1981, it continues to play an important role in treating community-acquired infections 5, 4
- The development of higher dosing regimens and pharmacokinetically-enhanced formulations has allowed Augmentin to remain effective despite increasing antimicrobial resistance 4