Will Augmentin (amoxicillin-clavulanate) treat streptococcal pharyngitis?

From the Guidelines

Augmentin (amoxicillin-clavulanate) is not the first-line treatment for strep throat, but it can be effective in certain cases, such as suspected beta-lactamase-producing bacteria, treatment failure with first-line antibiotics, or in patients with recurrent infections. The first-line treatment for strep throat is typically penicillin V or amoxicillin alone due to their narrower spectrum, lower cost, and continued effectiveness against Group A Streptococcus 1. According to the Infectious Diseases Society of America, penicillin V and amoxicillin are recommended as first-line treatments for GAS pharyngitis, with a strong, high-quality evidence rating 1.

Some key points to consider when treating strep throat include:

• The importance of accurate diagnosis to prevent unnecessary antibiotic use and reduce the risk of antibiotic resistance 1
• The need to consider factors such as efficacy, safety, antimicrobial spectrum, dosing schedule, compliance, and cost when selecting an antibiotic 1
• The potential for Augmentin to be used in cases where there is suspected beta-lactamase-producing bacteria, treatment failure with first-line antibiotics, or in patients with recurrent infections 1

It's also important to note that Augmentin carries a higher risk of gastrointestinal side effects like diarrhea compared to amoxicillin alone, and using broader-spectrum antibiotics when not necessary can contribute to antibiotic resistance 1. Therefore, the use of Augmentin should be reserved for specific cases where its benefits outweigh the risks, and first-line treatments should be used whenever possible. For adults, the typical dosage of Augmentin would be 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for 10 days, while for children, the dosage is weight-based, usually 45 mg/kg/day divided into two doses 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only),

• Augmentin, which contains amoxicillin, is indicated for the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus species, including strep throat.
• The drug label states that amoxicillin is effective against α-and β-hemolytic isolates of Streptococcus species, which are commonly associated with strep throat.
• However, it is essential to note that the effectiveness of amoxicillin against strep throat depends on the susceptibility of the specific Streptococcus isolate.
• As Augmentin is a combination of amoxicillin and clavulanic acid, it may be effective against β-lactamase-positive isolates, which are not susceptible to amoxicillin alone 2.
• Therefore, Augmentin may be used to treat strep throat, but it is crucial to consider the susceptibility of the specific isolate and local epidemiology when selecting therapy.

From the Research

Augmentin and Strep Throat Treatment

• Augmentin (amoxicillin/clavulanate) is a broad-spectrum antibacterial agent that has been used to treat various community-acquired respiratory tract infections, including those caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 3.
• However, for the treatment of strep throat, which is typically caused by Group A beta-hemolytic streptococcal pharyngitis, penicillin and amoxicillin are considered first-line antibiotics, with a recommended course of 10 days 4, 5, 6.
• Augmentin is not typically considered a first-line treatment for strep throat, but it may be used as an alternative in certain cases, such as in patients with penicillin allergy or in areas with high resistance to other antibiotics.
• A study comparing the efficacy of clarithromycin, amoxicillin/clavulanate, and penicillin V in the treatment of acute group A streptococcal tonsillopharyngitis found that amoxicillin/clavulanate had a similar clinical efficacy to penicillin V, but was more effective in eradicating the bacteria 7.

Efficacy of Augmentin in Treating Strep Throat

• The study mentioned above found that amoxicillin/clavulanate had a long-term Streptococcus pyogenes eradication rate of 83%, which was similar to that of penicillin V (77%) 7.
• However, it is essential to note that the efficacy of Augmentin in treating strep throat may vary depending on the specific circumstances, such as the presence of antibiotic-resistant strains or patient factors.
• In general, the use of Augmentin for the treatment of strep throat should be guided by clinical judgment and consideration of local antibiotic resistance patterns, as well as patient-specific factors such as allergy history and medication tolerance.