From the Guidelines
I strongly recommend proceeding with the ultrasound of the neck to evaluate the persistent left-sided neck pain in this 49-year-old male patient. Despite treatment with two broad-spectrum antibiotics (Augmentin 875/125 mg and Levaquin 750 mg), the patient's symptoms have not resolved, suggesting either antibiotic resistance, a non-bacterial cause, or a complication such as an abscess 1. The ultrasound will help visualize soft tissue structures, lymph nodes, blood vessels, and potential fluid collections that might be causing the persistent pain. If the ultrasound reveals an abscess, surgical drainage may be necessary. Other possibilities to consider include viral pharyngitis, which wouldn't respond to antibiotics, or non-infectious causes like cervical spine issues or referred pain.
Key Considerations
- The patient's symptoms have persisted despite broad-spectrum antibiotic treatment, indicating a possible need for alternative or additional therapies 1.
- The use of Augmentin 875/125 mg and Levaquin 750 mg may not be sufficient to cover all potential pathogens, including MRSA and some anaerobes, as noted in the guidelines for skin and soft tissue infections 1.
- Ultrasound is a valuable diagnostic tool for evaluating soft tissue structures and potential fluid collections in the neck.
Next Steps
- Proceed with the ultrasound of the neck to further assess the patient's condition.
- Consider alternative or additional antibiotic therapies based on the results of the ultrasound and potential culture results.
- Provide appropriate pain management and advise the patient to return immediately if symptoms worsen, particularly if they develop difficulty breathing or swallowing.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Treatment and Assessment
- The patient, a 49-year-old male, was treated with two different antibiotics, Augmentin 875/125 and Levaquin 750 mg, for an infection, but the symptoms persist.
- An ultrasound (US) of the neck has been prescribed for further assessment.
Antibiotic Effectiveness
- A study from 1999 2 compared the effectiveness of levofloxacin and amoxicillin-clavulanate for the treatment of acute sinusitis in adults, finding that both treatments had similar success rates, but levofloxacin had fewer drug-related adverse events.
- Another study from 2012 3 analyzed the microbiological aspects of odontogenic infections and found that moxifloxacin and amoxicillin-clavulanic acid had high susceptibility rates against the pathogens involved.
Antibiotic Resistance and Penetration
- A 2019 review 4 discussed the penetration of various antibiotics into bone and joint tissues, finding that most antibiotics, including amoxicillin, had good penetration profiles, but some exceptions included penicillin and metronidazole.
- A 2017 study 5 compared the MIC of amoxicillin/clavulanate according to CLSI and EUCAST methodologies, finding discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae.
Treatment of Infections
- A 2024 study 6 evaluated the use of oral amoxicillin/clavulanate for urinary tract infections caused by ceftriaxone non-susceptible Enterobacterales, finding that it may be a useful alternative therapy.
- A 2012 study 3 found that moxifloxacin had high in vitro activity against odontogenic bacteria, corresponding well to its clinical results in the treatment of odontogenic abscesses and infiltrates.