What is Co-Amoxiclav and Cost Comparison with Clarithromycin
Co-amoxiclav (Augmentin) is a combination antibiotic containing amoxicillin and clavulanic acid, and it is generally cheaper than clarithromycin, though for severe influenza-related pneumonia, co-amoxiclav plus a macrolide (like clarithromycin) is the preferred treatment, not one or the other alone. 1, 2
What is Co-Amoxiclav?
Co-amoxiclav is a β-lactamase stable antibiotic that combines amoxicillin (a penicillin) with clavulanic acid (a β-lactamase inhibitor). 3 This combination:
- Provides broad-spectrum coverage against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus 1, 3
- Overcomes β-lactamase resistance, which is critical since 18-42% of H. influenzae isolates produce β-lactamase and are resistant to plain amoxicillin 4, 5
- Has been used successfully for over 20 years in treating community-acquired respiratory tract infections with maintained efficacy despite rising antimicrobial resistance 3
Treatment for Severe Influenza-Related Pneumonia
For your specific clinical scenario of severe influenza-related pneumonia, neither co-amoxiclav nor clarithromycin alone is adequate—you need combination therapy. 1, 2
Preferred Regimen for Severe Disease:
- IV co-amoxiclav 1.2g three times daily PLUS IV clarithromycin 500mg twice daily (or erythromycin 500mg four times daily) 1
- Alternative: IV cefuroxime 1.5g three times daily or IV cefotaxime 1g three times daily PLUS a macrolide 1, 2
Why Combination Therapy is Essential:
- Dual coverage for predominant pathogens (S. pneumoniae and S. aureus) improves outcomes in severe pneumonia 1
- Covers atypical pathogens including Legionella species, which may not be distinguishable from influenza-related pneumonia at presentation 1, 2
- Covers Gram-negative enteric bacilli, which though uncommon, carry high mortality 1
- Ensures prompt, high blood and lung concentrations through parenteral administration 1
Cost Considerations
While specific pricing varies by region and healthcare system, co-amoxiclav is generally less expensive than clarithromycin due to:
- Longer market availability and generic formulations 3
- Simpler manufacturing process
- More widespread use reducing per-unit costs 6
However, cost should not drive the decision in severe pneumonia—the mortality benefit of appropriate combination therapy far outweighs any cost differential. 7, 8
Critical Treatment Timing
- Administer antibiotics within 4 hours of hospital admission for non-severe pneumonia 1
- For severe pneumonia, give antibiotics immediately without delay by the admitting physician 1
- Delays in antibiotic administration are associated with increased mortality, particularly in elderly patients 1
When to Switch to Oral Therapy
Switch from IV to oral antibiotics when: 1
- Clinical improvement occurs
- Temperature has been normal for 24 hours
- No contraindication to oral route exists
Treatment duration: 1
- 7 days for non-severe, uncomplicated pneumonia
- 10 days for severe, microbiologically undefined pneumonia
Common Pitfall to Avoid
Do not use clarithromycin as monotherapy for severe influenza-related pneumonia—it lacks adequate coverage for the full spectrum of bacterial pathogens, particularly β-lactamase-producing organisms and S. aureus. 1, 6 The combination approach is mandatory for severe disease. 2