What is the efficacy of azithromycin (Z-pack) and amoxicillin-clavulanate (Augmentin) for treating pneumonia?

From the Guidelines

For community-acquired pneumonia in otherwise healthy adults, a Z-pack (azithromycin) is often prescribed as it effectively targets common respiratory pathogens like Streptococcus pneumoniae and atypical bacteria, while Augmentin (amoxicillin-clavulanate) is preferred when there's concern for bacteria that produce beta-lactamase enzymes or when treating aspiration pneumonia. The choice between these medications depends on the suspected cause of pneumonia, patient allergies, and risk factors. According to the most recent guidelines 1, for outpatient treatment, a macrolide (such as azithromycin) or doxycycline is recommended for previously healthy patients with no risk factors for drug-resistant Streptococcus pneumoniae (DRSP) infection. However, for patients with comorbidities or recent antimicrobial therapy, a respiratory fluoroquinolone or a combination of a beta-lactam (such as amoxicillin-clavulanate) and a macrolide is recommended.

• The suspected cause of pneumonia is a key factor in choosing between Z-pack and Augmentin, with Z-pack being effective against atypical bacteria and Augmentin being effective against bacteria that produce beta-lactamase enzymes.
• Patient allergies and risk factors, such as comorbidities or recent antimicrobial therapy, also play a crucial role in selecting the appropriate antibiotic therapy.
• Sometimes, Z-pack and Augmentin may be used together for broader coverage in severe cases of pneumonia.
• Both medications can cause side effects, with Z-pack potentially affecting heart rhythm in some patients and Augmentin commonly causing gastrointestinal issues like diarrhea.
• It is essential to note that neither Z-pack nor Augmentin should be taken without a proper diagnosis and prescription, as pneumonia requires proper evaluation to determine the appropriate antibiotic therapy, as stated in the guidelines 1.

From the Research

Antibiotic Treatment for Pneumonia

• The use of antibiotics such as zpack (azithromycin) and augmentin (amoxicillin/clavulanate) for the treatment of pneumonia is supported by various studies 2, 3, 4, 5, 6.
• According to a study published in 2016, the treatment of community-acquired pneumonia (CAP) requires expedient delivery of appropriate antibiotic therapy tailored to both the likely offending pathogens and the severity of disease 2.
• Another study published in 2004 found that amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been available for clinical use in a wide range of indications for over 20 years and is now used primarily in the treatment of community-acquired respiratory tract infections 3.

Efficacy of Augmentin

• A study published in 2000 found that amoxicillin-clavulanic acid is highly effective against penicillin-susceptible and intermediate-resistant strains of S. pneumoniae, with a high survival rate when treatment is started early 4.
• The study also found that the efficacy of amoxicillin-clavulanic acid is related mainly to the time that the antibiotic concentration exceeds the minimum inhibitory concentration (T>MIC) of the microorganism 4.

Susceptibility of Pathogens

• A study published in 2004 found that among S. pneumoniae isolates, >99% were susceptible to respiratory fluoroquinolones, 91.6% to amoxicillin, and 92.1% to amoxicillin/clavulanic acid 5.
• Another study published in 2009 found that among non-typeable H. influenzae, 42% produced beta-lactamase, but virtually all were susceptible to amoxicillin/clavulanic acid and ceftriaxone 6.
• The study also found that among S. pneumoniae isolates, 86 were penicillin-susceptible, 60 were penicillin-intermediate, and 62 were penicillin-resistant, with varying susceptibility to different antibiotics 6.