Can Augmentin Be Used for Strep Throat?
Augmentin (amoxicillin-clavulanate) can be used for strep throat, but it should NOT be your first-line choice for uncomplicated cases—reserve it for recurrent infections or chronic carriers where standard penicillin or amoxicillin has failed. 1, 2
Why Augmentin Is NOT First-Line
- Group A Streptococcus does not produce beta-lactamases, so the clavulanate component provides no additional benefit over plain amoxicillin or penicillin in typical strep throat. 3
- No documented penicillin resistance exists in Group A Streptococcus anywhere in the world, making the addition of clavulanate unnecessary for initial treatment. 1, 3
- Augmentin has a broader antimicrobial spectrum than penicillin, which unnecessarily selects for antibiotic-resistant flora when narrow-spectrum agents would suffice. 1, 2
- Augmentin costs significantly more than penicillin or amoxicillin, even for short courses. 1, 2
- Augmentin causes more gastrointestinal side effects due to its broader spectrum—one study showed significantly higher rates of GI adverse events compared to cefaclor in pediatric pharyngotonsillitis. 4
When Augmentin IS Appropriate
Use Augmentin specifically for these scenarios:
- Recurrent streptococcal pharyngitis (multiple episodes within months despite appropriate initial therapy)—Augmentin yields high rates of pharyngeal eradication in this setting. 1, 2
- Chronic streptococcal carriers who have failed standard penicillin or amoxicillin treatment—the clavulanate component overcomes beta-lactamase production by oral flora that may protect Group A Streptococcus from penicillin. 1, 2
- Treatment failures after a full 10-day course of penicillin or amoxicillin—Augmentin is listed as one of several regimens "substantially more effective than penicillin or amoxicillin in eliminating chronic streptococcal carriage." 1
Correct Dosing When You Do Use Augmentin
- Adults and children: 40 mg amoxicillin/kg/day divided into 3 doses (maximum 2000 mg amoxicillin/day) for 10 full days. 1
- The full 10-day course is mandatory to achieve maximal pharyngeal eradication and prevent acute rheumatic fever, even if symptoms resolve in 3–4 days. 1, 2
- Do not shorten the course—even reducing treatment by a few days results in appreciable increases in treatment failure rates and rheumatic fever risk. 1, 2
What You SHOULD Use First-Line
- Penicillin V (250 mg four times daily or 500 mg twice daily for 10 days) or amoxicillin (50 mg/kg once daily, maximum 1000 mg, for 10 days) remain the drugs of choice due to proven efficacy, narrow spectrum, safety, and low cost. 2, 3
- Intramuscular benzathine penicillin G (600,000 U for <27 kg; 1,200,000 U for ≥27 kg as a single dose) is preferred when compliance with oral therapy is unlikely. 1, 3
Common Pitfall to Avoid
Do not prescribe Augmentin for initial, uncomplicated strep throat—this unnecessarily broadens antibiotic spectrum, increases cost, raises the risk of adverse effects, and promotes antibiotic resistance when narrow-spectrum penicillin would be equally effective. 1, 2