From the Guidelines
Amoxicillin-clavulanate is the recommended antibiotic to cover Haemophilus influenzae type b (Hib), Streptococcus pyogenes (Group A Strep), and Streptococcus pneumoniae. For adults, the typical dosage is 875/125 mg twice daily for 7-10 days, while children receive 45 mg/kg/day divided twice daily based on the amoxicillin component 1. Alternative options include third-generation cephalosporins like ceftriaxone (1-2 g IV daily for adults) or cefotaxime. For penicillin-allergic patients, a combination of clindamycin plus a fluoroquinolone like levofloxacin may be used, or macrolides like azithromycin, though resistance patterns should be considered 1.
Some key points to consider when choosing an antibiotic include:
- The severity of the infection and the patient's overall health
- The likelihood of resistance to certain antibiotics in the local area
- The potential for side effects and interactions with other medications
- The need for hospitalization or outpatient treatment
According to the guidelines, amoxicillin-clavulanate is effective because it combines amoxicillin, which inhibits bacterial cell wall synthesis, with clavulanate, which prevents beta-lactamase enzymes from inactivating the amoxicillin 1. This combination provides coverage against beta-lactamase-producing H. influenzae while maintaining excellent activity against streptococci. Treatment duration should be determined based on the specific infection being treated, with reassessment after 48-72 hours to ensure clinical improvement.
It's also important to note that for children with drug allergy to recommended therapy, treatment should be individualized, and options may include a trial of amoxicillin under medical observation, a trial of an oral cephalosporin, or treatment with levofloxacin, linezolid, clindamycin, or a macrolide 1.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of adults (≥ 18 years of age) with mild, moderate, and severe infections caused by susceptible isolates of the designated microorganisms in the conditions listed in this section
1 Nosocomial Pneumonia Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae.
2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae
4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
6 Complicated Skin and Skin Structure Infections Levofloxacin tablets are indicated for the treatment of complicated skin and skin structure infections due to methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis
7 Uncomplicated Skin and Skin Structure Infections Levofloxacin tablets are indicated for the treatment of uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes.
Levofloxacin can be used to cover Hib, Strep A, and Strep pneumoniae.
- Strep pneumoniae is covered in the treatment of community-acquired pneumonia, nosocomial pneumonia, and acute bacterial sinusitis.
- Hib (Haemophilus influenzae) is covered in the treatment of community-acquired pneumonia, nosocomial pneumonia, and acute bacterial sinusitis.
- Strep A (Streptococcus pyogenes) is covered in the treatment of complicated skin and skin structure infections and uncomplicated skin and skin structure infections. 2
From the Research
Antibiotic Coverage for Hib, Strep A, and Strep Pneumonia
To determine the appropriate antibiotic coverage for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (Strep pneumonia), and Streptococcus pyogenes (Strep A), we must consider the common causes of bacterial infections and the effectiveness of various antibiotics against these pathogens.
- Hib and Strep Pneumonia: Studies have shown that Hib and Strep pneumonia are significant causes of bacterial acute otitis media (AOM) and pneumonia in children 3, 4. Amoxicillin/clavulanate has been found to be effective against these pathogens, despite high antibiotic resistance 3.
- Strep A: While Strep A is a common cause of pharyngitis, it is less commonly associated with AOM and pneumonia. However, it is still important to consider Strep A when selecting antibiotic coverage.
- Antibiotic Options: Based on the available evidence, amoxicillin/clavulanate may be a suitable option for covering Hib, Strep pneumonia, and Strep A 3. However, it is essential to note that antibiotic resistance patterns can vary by region and over time.
Considerations for Antibiotic Selection
When selecting an antibiotic to cover Hib, Strep A, and Strep pneumonia, it is crucial to consider the following factors:
- Local Resistance Patterns: Antibiotic resistance patterns can vary significantly by region and over time. It is essential to stay up-to-date with local resistance patterns to ensure effective treatment.
- Vaccination Status: Vaccination against Hib and Strep pneumonia can significantly reduce the risk of infection. Considering the patient's vaccination status can help guide antibiotic selection.
- Clinical Presentation: The clinical presentation of the patient, including symptoms and severity of illness, can also inform antibiotic selection.