Does Augmentin Cover UTI?
Yes, Augmentin (amoxicillin-clavulanate) is effective for treating uncomplicated lower urinary tract infections (cystitis) in both women and men, but it is NOT recommended as first-line empirical therapy for complicated UTIs with systemic symptoms, pyelonephritis, or catheter-associated UTIs.
Uncomplicated Cystitis (Lower UTI)
Augmentin is a WHO-recommended first-choice option for uncomplicated lower UTIs, alongside nitrofurantoin and trimethoprim-sulfamethoxazole, as E. coli susceptibility to amoxicillin-clavulanate remains generally high 1. However, it is considered appropriate only when other recommended agents (trimethoprim-sulfamethoxazole, nitrofurantoin, fosfomycin) cannot be used, as beta-lactams generally have inferior efficacy and more adverse effects compared to other UTI antimicrobials 2.
Treatment Duration
- Women with uncomplicated cystitis: 3-5 days 1
- Men with uncomplicated cystitis: 7 days (to account for possible occult prostatitis) 1
Critical Resistance Threshold
- Check local E. coli resistance patterns before prescribing 1
- Do not use empirically if local resistance exceeds 20% 1
- Never use plain amoxicillin alone for UTIs—only the amoxicillin-clavulanate combination works, as clavulanate overcomes beta-lactamase resistance 1
When to Avoid
- Recent Augmentin exposure within 6 weeks (increased resistance risk) 1
- Known local resistance rates >20% 1
Complicated UTIs and Upper Tract Infections
Augmentin should NOT be used as empirical monotherapy for complicated UTIs with systemic symptoms. The European Association of Urology recommends combination therapy instead 2, 1:
- Amoxicillin plus an aminoglycoside 2
- Second-generation cephalosporin plus an aminoglycoside 2
- Intravenous third-generation cephalosporin 2
Pyelonephritis
Augmentin is NOT a first-line choice for pyelonephritis 1. WHO guidelines recommend:
- Mild-to-moderate cases: Ciprofloxacin or ceftriaxone/cefotaxime 1
- Severe pyelonephritis: Ceftriaxone/cefotaxime as first choice, amikacin as second choice 1
Catheter-Associated UTIs
Do not use Augmentin as empiric therapy for catheter-associated UTIs 1. These infections require different empirical coverage given the higher likelihood of resistant organisms and the 10% mortality associated with secondary bacteremia from CA-UTIs 2.
Common Pitfalls to Avoid
- Never prescribe amoxicillin alone—it has very high worldwide resistance rates and poor efficacy for UTIs 2, 1
- Do not use for urosepsis or complicated UTIs as monotherapy—these require broader spectrum coverage 1
- Avoid in hospitalized patients or those with recent fluoroquinolone/beta-lactam exposure—resistance is more likely 2
- Always obtain urine culture for complicated UTIs, pyelonephritis, or treatment failures to guide targeted therapy 2