Can Tamiflu and Augmentin Be Given Together for Flu?
Yes, Tamiflu (oseltamivir) and Augmentin (amoxicillin-clavulanate) can be given together, but Augmentin should only be added when there is clinical suspicion or confirmation of a secondary bacterial infection complicating influenza—not for uncomplicated flu alone.
When to Use Oseltamivir Alone
Oseltamivir is the primary treatment for influenza and should be initiated as soon as possible in patients with suspected or confirmed flu, particularly those who are hospitalized, severely ill, or at high risk for complications 1, 2.
Treatment should begin empirically during influenza season without waiting for laboratory confirmation, especially in high-risk patients 1, 2.
Oseltamivir works against the influenza virus itself by inhibiting viral neuraminidase, reducing viral replication and shedding 3, 4.
When to Add Augmentin (or Another Antibiotic)
Antibiotics like Augmentin have no direct effect on influenza viruses and should not be used routinely for uncomplicated influenza 5.
Add antibiotics when secondary bacterial complications develop, such as:
- Bacterial pneumonia (new infiltrate on chest imaging, productive purulent sputum, elevated white blood cell count) 5
- Acute otitis media (particularly common in children with influenza) 5, 1
- Bacterial sinusitis with persistent symptoms beyond typical viral course 5
- Clinical deterioration after initial improvement, suggesting bacterial superinfection 5
One study showed that oseltamivir treatment reduced complications requiring antibiotic therapy by approximately 50% compared to placebo, suggesting that early antiviral treatment may prevent the need for antibiotics altogether 5.
Clinical Decision Algorithm
For uncomplicated influenza:
- Start oseltamivir 75 mg twice daily for 5 days (adults) or weight-based dosing in children 1, 2
- Do NOT add antibiotics 5
For influenza with suspected bacterial superinfection:
- Continue oseltamivir AND add appropriate antibiotic coverage (such as Augmentin for community-acquired bacterial pneumonia or otitis media) 5
- The combination is safe with no known drug interactions between these medications 5
Important Caveats
The most common mistake is prescribing antibiotics for viral influenza symptoms alone, which contributes to antibiotic resistance without providing benefit 5.
Oseltamivir reduces the risk of pneumonia by 50% and otitis media by 34% when started early, potentially eliminating the need for antibiotics 1, 6.
High-risk patients (elderly, immunocompromised, chronic cardiac/pulmonary disease, pregnant women) should receive oseltamivir regardless of symptom duration, even beyond 48 hours 1, 2.
The benefit of oseltamivir is greatest when started within 48 hours of symptom onset, but treatment beyond this window still provides mortality benefit in severely ill or high-risk patients 1, 2.