From the Guidelines
Adding doxycycline to augmentin for pneumonia is conditionally recommended for outpatient adults with comorbidities, as it provides broader coverage against atypical pathogens. The recommended approach is to combine amoxicillin-clavulanate (Augmentin) with doxycycline, with typical dosing being Augmentin 875/125 mg twice daily plus doxycycline 100 mg twice daily 1. This combination therapy addresses both typical bacterial pathogens (covered by Augmentin) and atypical organisms like Mycoplasma, Chlamydia, and Legionella (covered by doxycycline) 1. Key considerations for this combination include:
- Patients should take doxycycline with food to reduce stomach upset
- Avoid dairy products or antacids within 2 hours of taking it
- Stay upright for 30 minutes after dosing to prevent esophageal irritation
- Sun protection is also important as doxycycline can cause photosensitivity However, it's essential to note that for severe CAP, combination therapy with a b-lactam plus a macrolide or a b-lactam plus a respiratory fluoroquinolone is recommended, and the combination of b-lactam plus doxycycline has not been well studied in this context 1. Therefore, the decision to add doxycycline to augmentin should be made on a case-by-case basis, considering the severity of the pneumonia, the presence of comorbidities, and the suspected causative pathogens.
From the Research
Adding Doxy to Augmentin for Pneumonia
- The use of doxycycline in combination with Augmentin (amoxicillin/clavulanate) for the treatment of pneumonia is not directly addressed in the provided studies.
- However, the efficacy of doxycycline as a treatment option for mild-to-moderate community-acquired pneumonia (CAP) in adults has been evaluated in a systematic review and meta-analysis 2.
- The study found that doxycycline had a comparable clinical cure rate to macrolides or fluoroquinolones in mild-to-moderate CAP, suggesting that it could be a viable treatment option.
- Augmentin, on the other hand, has been shown to be effective in the treatment of community-acquired respiratory tract infections, including pneumonia, due to its broad-spectrum antibacterial activity and favorable pharmacokinetic/pharmacodynamic profile 3.
- The combination of amoxicillin/clavulanate with clarithromycin has been compared to levofloxacin in the treatment of hospitalized patients with community-acquired pneumonia, with similar clinical response rates observed between the two groups 4.
- While there is no direct evidence to support the use of doxycycline in combination with Augmentin for pneumonia, the available data suggest that both agents have a role in the treatment of CAP, and further studies may be needed to evaluate their combined efficacy and safety.
Treatment Options for Community-Acquired Pneumonia
- Various antibiotics, including amoxicillin/clavulanate, clarithromycin, and levofloxacin, have been evaluated for the treatment of CAP in outpatient settings, with no significant differences in efficacy observed between them 5.
- The choice of antibiotic for CAP should be based on factors such as the severity of the disease, the presence of comorbidities, and the likelihood of antibiotic resistance.
- Doxycycline may be considered as a treatment option for mild-to-moderate CAP, particularly in cases where other antibiotics are not suitable or are contraindicated 2.