Augmentin is Not Appropriate for Bloodstream Infections with Gram-Negative Bacilli
Augmentin (co-amoxiclav) is not appropriate for treating bloodstream infections with gram-negative bacilli in aerobic blood cultures. Patients with gram-negative bacteremia require more potent broad-spectrum antibiotics with reliable gram-negative coverage 1.
Recommended Treatment Approach for Gram-Negative Bacteremia
Initial Empiric Therapy
- Patients with gram-negative bacteremia should receive empirical antibiotic therapy with agents that have reliable activity against gram-negative bacilli, especially if they are critically ill, have sepsis, are neutropenic, have a femoral catheter, or have a known focus of gram-negative infection 1
- For critically ill patients with suspected gram-negative bacteremia and recent colonization or infection with multidrug-resistant (MDR) gram-negative pathogens, two antimicrobial agents of different classes with gram-negative activity should be administered as initial therapy 1
- Recommended empiric regimens include:
Definitive Therapy
- Once culture and susceptibility results are available, de-escalation to a single appropriate antibiotic is recommended 1
- For persistent bacteremia or severe sepsis despite appropriate therapy, the intravascular device should be removed, and evaluation for endovascular or metastatic infection should be pursued 1
- Treatment duration should be 7-14 days for uncomplicated bacteremia, with longer courses needed for complicated infections 1
Why Augmentin is Inadequate for Gram-Negative Bacteremia
- While Augmentin has activity against some gram-negative organisms, it lacks reliable coverage against many gram-negative bacilli commonly causing bloodstream infections 2, 3
- Augmentin is primarily indicated for community-acquired respiratory tract infections, not for serious bloodstream infections 4
- For bloodstream infections with gram-negative bacilli, particularly in critically ill patients, more potent agents are required to ensure adequate coverage 1
- The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines recommend more potent agents for treating infections caused by multidrug-resistant gram-negative bacilli 1
Special Considerations
- For patients with neutropenia and gram-negative bacteremia, broad-spectrum antibiotics with reliable gram-negative coverage are essential 1
- For catheter-related bloodstream infections with gram-negative bacilli, catheter removal should be considered, especially for infections with Pseudomonas species, Burkholderia cepacia, Acinetobacter baumannii, and Stenotrophomonas species 1
- For non-HACEK gram-negative bacilli causing endovascular infections, combination therapy with a β-lactam (penicillins, cephalosporins, or carbapenems) and either an aminoglycoside or fluoroquinolone for 6 weeks is recommended 1
Common Pitfalls to Avoid
- Using inadequate antimicrobial therapy with limited gram-negative coverage (like Augmentin) for bloodstream infections, which can lead to increased morbidity and mortality 1, 5
- Delaying appropriate broad-spectrum antibiotic therapy in patients with suspected gram-negative bacteremia 1
- Failing to remove infected intravascular devices in cases of persistent bacteremia despite appropriate antimicrobial therapy 1
- Using narrow-spectrum antibiotics that don't adequately cover gram-negative organisms in critically ill patients 6
In conclusion, Augmentin is not an appropriate choice for treating bloodstream infections with gram-negative bacilli. More potent broad-spectrum antibiotics with reliable gram-negative coverage should be used based on local susceptibility patterns and patient-specific factors.