From the Guidelines
For a patient who started on Augmentin for acute otitis media (AOM) and then had a throat culture come back positive for strep two days later, it is reasonable to continue with Augmentin rather than switching to amoxicillin. The patient is already on a broad-spectrum antibiotic that covers both the common pathogens causing AOM and Group A Streptococcus that causes strep throat, as indicated in the treatment guidelines for Group A streptococcal pharyngitis 1. Some key points to consider in this scenario include:
- The effectiveness of Augmentin (amoxicillin-clavulanate) against both infections, as it is listed as a treatment option for chronic carriers of Group A Streptococci with a strength of recommendation of Strong, moderate 1.
- The importance of completing the full course of antibiotics to ensure eradication of both infections, typically 10 days.
- The broader coverage provided by Augmentin compared to amoxicillin alone due to the addition of clavulanic acid, which helps overcome certain resistance mechanisms.
- The practicality of continuing Augmentin since the patient already has the medication, avoiding the need for a new prescription and potential confusion with medication changes. Given the information provided and the treatment guidelines, continuing Augmentin is the most appropriate course of action to effectively treat both the AOM and the strep throat, prioritizing the patient's morbidity, mortality, and quality of life.
From the Research
Treatment Options for Streptococcal Pharyngitis
- The patient was initially started on Augmentin for Acute Otitis Media (AOM) and then 2 days later, a throat culture came back positive for strep.
- According to the studies, penicillin and amoxicillin are first-line antibiotics for the treatment of streptococcal pharyngitis, with a recommended course of 10 days 2, 3.
- Augmentin is a combination of amoxicillin and clavulanic acid, and while amoxicillin is effective against streptococcal pharyngitis, the addition of clavulanic acid may not be necessary for this specific infection.
Switching to Amoxicillin
- Considering the patient has already been started on Augmentin, switching to amoxicillin may not be necessary, as amoxicillin is a component of Augmentin and is effective against streptococcal pharyngitis 2, 3.
- However, if the decision is made to switch, amoxicillin would be a suitable alternative, with a recommended course of 10 days 2, 3.
Resistance and Efficacy
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States, making them less effective options for the treatment of streptococcal pharyngitis 2, 4, 5.
- Amoxicillin and penicillin have been shown to be effective in eradicating group A streptococci, with amoxicillin being more palatable than penicillin 2, 3.