Combination Therapy with Augmentin and Clarithromycin is NOT Recommended for Pharyngitis/Tonsillitis
The combination of Augmentin (amoxicillin-clavulanate) plus clarithromycin is not a standard or recommended treatment regimen for pharyngitis/tonsillitis caused by Group A Streptococcus (GAS). This combination represents unnecessary polytherapy with overlapping coverage and increased risk of adverse effects without proven benefit.
First-Line Treatment Recommendations
For non-penicillin-allergic patients, use amoxicillin or penicillin V alone as monotherapy for 10 days 1. These agents are recommended based on their narrow spectrum of activity, infrequency of adverse reactions, modest cost, and proven efficacy 1.
- Amoxicillin dosing: 50 mg/kg/day divided twice daily (maximum 1000 mg/day) for 10 days 2
- Penicillin-resistant GAS has never been documented, making these agents reliably effective 2
Treatment for Penicillin-Allergic Patients
For penicillin-allergic individuals, use clarithromycin OR a first-generation cephalosporin OR clindamycin as monotherapy—not in combination 1.
- Clarithromycin: 10 days of therapy 1
- First-generation cephalosporin (cefadroxil or cephalexin): 10 days for those without anaphylactic-type hypersensitivity 1
- Clindamycin: 10 days (resistance rate approximately 1% in the United States) 1
- Azithromycin: 5 days at 12 mg/kg/day (maximum 500 mg) 1
Why Combination Therapy is Inappropriate
Combining Augmentin with clarithromycin provides no additional benefit and increases risks:
- Both agents are effective as monotherapy against GAS 3, 4, 5
- Augmentin (amoxicillin-clavulanate) is reserved for specific scenarios such as documented treatment failure with standard penicillin therapy, not as first-line treatment 6
- The clavulanate component in Augmentin adds unnecessary broad-spectrum coverage and increases gastrointestinal side effects 1
- Macrolide resistance rates in the United States are approximately 5-8%, making clarithromycin alone reasonable when indicated 1
- Polytherapy increases cost, adverse effects (particularly gastrointestinal complaints), and promotes antibiotic resistance 1
When Augmentin May Be Considered (as Monotherapy)
Amoxicillin-clavulanate may be used alone (not combined with clarithromycin) only in specific circumstances:
- Documented treatment failure with persistent classic streptococcal symptoms after appropriate penicillin or amoxicillin therapy 6
- Consideration for GAS carrier eradication in special circumstances (community outbreak, personal/family history of rheumatic fever) 6
Common Pitfalls to Avoid
- Never use combination therapy when monotherapy is adequate 1
- Avoid broad-spectrum antibiotics when narrow-spectrum options remain effective 1, 6
- Do not prescribe antibiotics for viral pharyngitis features (cough, rhinorrhea, hoarseness, oral ulcers) 1, 7
- Complete the full 10-day course even when symptoms improve to prevent treatment failure and resistance 2
- Tetracyclines, sulfonamides, trimethoprim-sulfamethoxazole, and older fluoroquinolones should never be used as they are ineffective against GAS 1, 6