From the Guidelines
Augmentin (amoxicillin-clavulanate) should only be used for upper respiratory infections (URIs) when there are clear signs of bacterial infection, such as persistent symptoms beyond 10-14 days, high fever, purulent discharge, or worsening symptoms after initial improvement, as most URIs are viral in origin and do not require antibiotics at all. The use of Augmentin for URIs is supported by the 2012 IDSA clinical practice guidelines, which recommend empirical antibiotics as soon as a clinical diagnosis of ABRS is established on the basis of clinical criteria 1. Amoxicillin–clavulanate is the preferred agent, and doxycycline or a respiratory fluoroquinolone may be used as an alternative in patients with ABRS.
Some key points to consider when prescribing Augmentin for URIs include:
- Typical dosing for adults is 875/125 mg twice daily or 500/125 mg three times daily for 5-10 days depending on infection severity 1.
- Common side effects include diarrhea, nausea, and rash, and taking it with food can help reduce gastrointestinal side effects.
- Augmentin works by combining amoxicillin, which disrupts bacterial cell wall synthesis, with clavulanic acid, which inhibits beta-lactamase enzymes that some bacteria produce to resist amoxicillin alone.
- The American Academy of Otolaryngology–Head and Neck Surgery emphasizes watchful waiting (without antibiotic therapy) as initial management for all patients with uncomplicated ABRS, regardless of severity 1.
- Patients who are seriously ill, who deteriorate clinically despite antibiotic therapy, or who have recurrent episodes should be referred to a specialist (for example, an otolaryngologist, infectious disease specialist, or allergist) 1.
It's also important to note that acute uncomplicated rhinosinusitis is a self-limited infection that usually resolves without antibiotics, even in patients with a bacterial cause, and most patients diagnosed with acute rhinosinusitis have more adverse effects than benefits from antibiotics 1.
From the Research
Effectiveness of Augmentin for Upper Respiratory Tract Infections (URIs)
- Augmentin, also known as amoxicillin/clavulanate, is a broad-spectrum antibacterial agent used to treat various infections, including upper respiratory tract infections (URIs) 2.
- The effectiveness of Augmentin in treating URIs is supported by several studies, which demonstrate its high bacteriological and clinical efficacy in respiratory tract infections 2, 3.
- Augmentin is included in guidelines and recommendations for the treatment of bacterial sinusitis, acute otitis media, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 2.
Comparison with Other Antibiotics
- A study comparing the efficacy and safety of cefuroxime axetil and Augmentin in the treatment of upper respiratory tract infections found that both antibiotics had similar success rates, with Augmentin having a 98% success rate and cefuroxime axetil having a 97% success rate 3.
- Another study found that amoxicillin, a component of Augmentin, is the drug of choice for acute otitis media in children, and that Augmentin provides better coverage against beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis in children who fail amoxicillin therapy 4.
Guidelines and Recommendations
- The Infectious Diseases Society of Southern Africa recommends Augmentin as an alternative antibiotic choice for the treatment of upper respiratory tract infections, particularly in cases where the causative pathogen is suspected to be beta-lactamase-producing 5.
- The American Family Physician guidelines recommend judicious use of antibiotics, including Augmentin, for upper respiratory tract infections, and suggest that antibiotics may be indicated in patients with acute otitis media, group A beta-hemolytic streptococcal pharyngitis, epiglottitis, or bronchitis caused by pertussis 6.