Is Augmentin (Amoxicillin-Clavulanate) appropriate for a patient with productive cough, sore throat, fever, and shortness of breath?

Augmentin is Appropriate for This Patient if Pneumonia is Suspected

Based on the clinical presentation of productive cough, sore throat, fever, and shortness of breath, you must first determine whether this patient has community-acquired pneumonia (CAP) versus acute bronchitis—this distinction is critical because antibiotics are only indicated for pneumonia. 1

Clinical Decision Algorithm

Step 1: Rule Out Pneumonia Using Vital Signs and Physical Exam

For healthy immunocompetent adults younger than 70 years, pneumonia is unlikely if ALL of the following are absent: 1

• Tachycardia (heart rate >100 beats/min)
• Tachypnea (respiratory rate >24 breaths/min)
• Fever (oral temperature >38°C)
• Abnormal chest examination findings (rales, egophony, or tactile fremitus)

If ANY of these criteria are present, pneumonia must be suspected and antibiotics are indicated. 1

Step 2: If Pneumonia is Suspected—Augmentin is Appropriate

Amoxicillin-clavulanate is FDA-approved for lower respiratory tract infections caused by beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis. 2 The 2019 IDSA/ATS guidelines recommend beta-lactam with macrolide or respiratory fluoroquinolone for CAP in patients with comorbidities, making Augmentin an appropriate choice. 1

Prescribe antibiotics for a minimum of 5 days, with extension guided by clinical stability markers (resolution of vital sign abnormalities, ability to eat, normal mentation). 1

Step 3: If Pneumonia is Ruled Out—Do NOT Use Augmentin

If the patient does not meet pneumonia criteria, this is acute bronchitis, and antibiotics should NOT be prescribed. 1 The American College of Physicians explicitly recommends against antibiotic therapy in bronchitis unless pneumonia is suspected. 1

• More than 90% of acute cough illnesses in otherwise healthy patients are viral. 1
• Purulent sputum does NOT indicate bacterial infection—purulence results from inflammatory cells or sloughed epithelial cells and occurs with viral infections. 1
• A randomized controlled trial showed amoxicillin-clavulanate provided no benefit over placebo for acute bronchitis. 1

Management of Sore Throat Component

The sore throat requires separate evaluation: 1

• If the patient has cough, nasal congestion, or hoarseness, this is viral pharyngitis and does NOT require antibiotics. 1
• Only test for Group A Streptococcus if there is fever, tonsillar exudates, tender cervical adenopathy, and absence of cough. 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on purulent sputum alone—this is the most common error leading to inappropriate antibiotic use. 1
• Do not assume fever automatically means bacterial infection—most febrile respiratory illnesses are viral. 1
• Do not use antibiotics for acute bronchitis "just in case"—this increases adverse events (number needed to harm = 8) without benefit. 1
• Shortness of breath alone does not indicate pneumonia—you must document abnormal vital signs or chest exam findings. 1

If Augmentin is Prescribed for Confirmed Pneumonia

Standard dosing is amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days, or high-dose 2000/125 mg twice daily for drug-resistant pathogens. 1, 3, 4 The high-dose formulation provides extended therapeutic levels against Streptococcus pneumoniae with reduced penicillin susceptibility while maintaining coverage of beta-lactamase-producing organisms. 3, 4