Augmentin (Amoxicillin/Clavulanate) versus ...

Augmentin vs. Clarithromycin (Biaxin)

Rhinosinusitis

Both clarithromycin and amoxicillin/clavulanate are first line antibiotics for acute rhinosinusitis and are equally effective. Clarithromycin produces more rapid improvement in symptoms.

The study4 examined the efficacy of clarithromycin and amoxicillin/clavulanate for the treatment of acute rhinosinusitis relative to the patient's quality of life. Twenty patients completed the study. The six-item Symptom Severity Survey and the Rhinoconjunctivitis quality of life Questionnaire demonstrated significant improvement for all patients at week 4. This Survey demonstrated significant improvement for clarithromycin at 14 days and at 28 days, whereas amoxicillin/clavulanate patients demonstrated significant improvement in symptoms only at 28 days. The Rhinoconjunctivitis quality of life Questionnaire, which reflects the previous 2 weeks, demonstrated significant improvement for the amoxicillin/clavulanate patients at 28 days.


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Sinusitis

Clarithromycin ER is comparable, and for selected measures superior, to Augmentin in the treatment of acute bacterial sinusitis.

Results of randomized, investigator-blinded study comparing clarithromycin ER to amoxicillin/ clavulanate for acute bacterial sinusitis 3. Amoxicillin/ Clavulanat Clarithromycin ER
Regimen 875 mg/l25 mg twice daily for 14 days 1000 mg once daily for 14 days
Clinical cure rate was 97% (179/185) 98% (184/188)
Pathogen eradication rates 98% (61/62) 94% (61/65)
Radiological success rate 94%
Symptomatic improvement or relief Observed 2-5 days after the initiation of the treatment, with a significantly higher resolution rate of sinus pressure and improvement/resolution rate of nasal congestion with clarithromycin ER
Incidence of side effects comparable
Conclusion Clarithromycin ER is comparable, and for selected measures superior, to amoxicillin/clavulanate in patients with acute bacterial sinusitis

Chronic bronchitis

Both clarithromycin extended-release and Augmentin are effective in the treatment of acute exacerbation of chronic bronchitis. However, clarithromycin is better tolerated.

Results of multicenter, randomized, parallel-group, investigator-blinded study comparing clarithromycin ER to amoxicillin/ clavulanate for acute exacerbation of chronic bronchitis 2. Amoxicillin/ Clavulanat Clarithromycin ER
Regimen 875 mg twice daily for 10 days 1000 mg once daily for 7 days
Clinical cure rate 87% 85%
Bacteriologic cure rate 89% 92%
Pathogen eradication rate 89% 88%
Premature discontinuation 12% (17/145) 3% (4/142)
Side effects similar frequency
Taste alteration 1 of 145 patients 9 of 142 patients
Severity scores for gastrointestinal side effects 1.58 1.16

Otitis media

The efficacy of clarithromycin is comparable with Augmentin in the treatment of acute otitis media in children. Clarithromycin is better tolerated with a lower incidence of gastrointestinal side effects.

Results of randomized, investigator-blinded, multicenter trial comparing clarithromycin and amoxicillin/clavulanate in the treatment of acute otitis media in patients ages 6 months to 12 years 1. Amoxicillin/ Clavulanat Clarithromycin
Regimen 13.3 mg/kg 3 times daily for 10 days 7.5 mg/kg twice daily for 10 days
Successful clinical response 92%
(133 of 145 patients)
90%
(121 of 135 patients)
Clinical failure or relapse (Posttreatment Days 0 to 4) 8% (12 of 145) 10% (14 of 135)
Gastrointestinal adverse effects:
diarrhea 32% (57 of 177) 12% (19 of 161)

 

Augmentin vs. Cefuroxime (Ceftin)

Acute Otitis Media

There is evidence from a randomized study in children 6–36 months of age with acute otitis media that a 5-day regimen of cefuroxime axetil is as effective as and may be better tolerated than an 8- or 10-day regimen of amoxicillin/clavulanate8.

Acute Otitis Media with Effusion

Cefuroxime axetil suspension 15 mg/kg twice daily is as effective as amoxicillin/clavulanate suspension 13.3 mg/kg three times daily in children diagnosed with acute otitis media with effusion, but produces fewer gastrointestinal side effects, particularly diarrhea9.

Bronchitis

Cefuroxime axetil is as effective as amoxicillin/clavulanate in the treatment of acute bronchitis. Cefuroxime produces fewer diarrhea and nausea.

Two independent, investigator-blinded, multicenter, randomized clinical trials10 compared the clinical and bacteriologic efficacy and safety of cefuroxime axetil and amoxicillin/clavulanate, in the treatment of secondary bacterial infections of acute bronchitis. Three hundred sixty patients with acute bronchitis were enrolled at 22 centers and were randomly assigned to receive 10 days of either cefuroxime axetil 250 mg twice daily (BID) (n= 177) or amoxicillin/clavulanate 500 mg three times daily (TID) (n = 183).

A satisfactory clinical outcome (cure or improvement) was achieved in 86% (117 of 136) and 83% (130 of 157) of the patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively. With respect to the eradication of bacterial pathogens, a satisfactory outcome (cure, presumed care, or cure with colonization) was obtained in 91% (53 of 58) and 86% (60 of 70) of patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively. Amoxicillin/clavulanate was associated with a significantly higher incidence of side effects than cefuroxime axetil (39% vs 23%), primarily reflecting a higher incidence of gastrointestinal adverse effects (37% vs 15%), particularly diarrhea and nausea. Four patients on cefuroxime axetil and eight patients on amoxicillin/clavulanate withdrew from the study because of adverse effects.

Community-acquired pneumonia

Cefuroxime axetil is as effective as Augmentin in the treatment of outpatients with mild to moderate community-acquired pneumonia.

Results of comparison of cefuroxime axetil and amoxycillin/clavulanate in the treatment of community-acquired pneumonia 11. Amoxicillin/ Clavulanat Cefuroxime axetil
Regimen 500 mg/125 mg 3 times daily for 10 days 500 mg twice daily 10 days
Cure or improvement 96% (49 of 51) 100% (55 of 55)
Eradication of bacterial pathogens 93% (37 of 40) 94% (32 of 34)
Gastrointestinal, side effects 8% 4%

Sinusitis

Cefuroxime axetil is as effective as Augmentin in the treatment of acute bacterial sinusitis but produces fewer side effects.

Multicenter study12 compared the clinical and bacteriologic efficacy of cefuroxime axetil and amoxicillin/clavulanate, in the treatment of acute bacterial maxillary sinusitis. A satisfactory clinical outcome (cure or improvement) was achieved in 85% (98 of 115) and 82% (102 of 124) of patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively. With respect to the eradication of the bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 84% (31 of 37) and 87% (34 of 39) of patients treated with cefuroxime axetil or amoxicillin/clavulanate, respectively. Amoxicillin/clavulanate was associated with a significantly higher incidence of adverse effects (13% versus 3%), particularly diarrhea (8% versus 1%).

Augmentin vs. Cefdinir

Acute otitis media

High-dose amoxicillin/clavulanic acid is significantly more effective than cefdinir as a therapy for children with acute otitis media (AOM).

The study14 compared the clinical efficacy of amoxicillin/clavulanic acid high-dose therapy for 10 days with cefdinir therapy for 5 days for acute otitis media at recommended doses. Children treated with amoxicillin/clavulanic acid had a better cure rate (86.5%) than children treated with cefdinir (71.0%). Cefdinir was correlated with less frequent cure results as children increased in age between 6 and 24 months.

Augmentin vs. Levofloxacin (Levaquin)

Otitis media

Levofloxacin and amoxicillin/clavulanate are similarly effective for recurrent acute otitis media.

In an evaluator-blinded, active-comparator, noninferiority, multicenter study7, children (6 months to < 5 years) were randomized to receive levofloxacin (10 mg/kg twice daily) or amoxicillin/clavulanate (14:1; amoxicillin 45 mg/kg twice daily) for 10 days. 630 children received levofloxacin and 675 received levofloxacin. Clinical cure (resolution of signs and symptoms) rates were 72.4% (456 of 630) in levofloxacin-treated and 69.9% (472 of 675) in amoxicillin/clavulanate-treated children. Cure rates were also similar for levofloxacin and comparator for each age group (< or =24 months: 68.9% versus 66.2%; > 24 months: 76.9% versus 75.1%; respectively). Cure rates at last visit (10-17 days after the last dose) were 74.9% and 73.8% in levofloxacin and amoxicillin/clavulanate groups, respectively. Thus, levofloxacin was found to be non-inferior to amoxicillin/clavulanate overall and in both infants (6 months to 2 years) and children 2-5 years. No differences regarding the frequency or type of side effects were observed.

Sinusitis

Levofloxacin is as effective and safe as Augmentin in the treatment of maxillary sinusitis. Levofloxacin is more effective in the bacteriological eradication of the infection.

Results of randomized comparative study of levofloxacin and amoxicillin/clavulanic acid in the treatment of purulent sinusitis in adults 6. Co-amoxiclav Levofloxacin
Regimen 625 mg 3 times a day for 14 days 300 mg orally once daily for 14 days
Radiological improvement 61.5%
(26.9% resolution, 34.6% improvement)
61.8%
(41.2% resolution, 20.6% improvement)
Positive pretreatment maxillary antral aspiration cultures 20 patients (76.9%) 28 patients (82.4%)
Bacteriological eradication 70.0% 78.5%
Eradication rate for major pathogens of acute sinusitis:
S. pneumoniae 100% 100%
S. aureus 100% 100%
Neisseria species 50% 100%
P. aeruginosa 0% 66.7%
Side effects (mainly nausea, abdominal ache, and diarrhea) 7.7% 8.8%

Chronic bronchitis

Levofloxacin appears to be slightly more effective than Augmentin for acute bacterial exacerbation of chronic bronchitis.

Post hoc analysis5 of data from a previous randomized, blinded, multicenter, parallel, noninferiority study assessed the bacterial etiology, symptom resolution, and tolerability of severe acute bacterial exacerbation of chronic bronchitis (ABECB) patients treated with either levofloxacin for 5 days or amoxicillin/clavulanate for 10 days. And 175 patients were microbiologically assessable (86 treated with levofloxacin and 89 treated with amoxicillin/clavulanate). At the on-treatment visit, a significantly higher proportion of patients in the levofloxacin group resolved purulent sputum production (57.5% vs 35.6%), sputum production (65.4% vs 45.3%), and cough (60.0% vs 44.0%), compared with the amoxicillin/clavulanate group. However, no significant between-group differences were observed at posttreatment. A total of 341 pathogens were isolated, of which 143 (41.9%) were traditional ABECB flora, 181 (53.1%) were other gram-negative organisms, and 17 (5.0%) were gram-positive organisms. Overall susceptibility of the pathogens was 97.1% for levofloxacin and 90.6% for amoxicillin/clavulanate. The prevalence of adverse events was 42.1 % in patients who received levofloxacin and 48.6 % in those who received amoxicillin/clavulanate.

Augmentin vs. Doxycycline

Tracheobronchitis

Doxycycline and Augmentin are equally effective in the treatment of tracheobronchitis in adults. Gastrointestinal side effects occur more frequently with Augmentin.

Doxycycline and co-amoxiclav were compared in a randomized clinical trial13 in patients with acute suppurative tracheobronchitis. Patients were treated for 5 to 10 days with either antibiotic following three schemes: co-amoxiclav 500 mg three times daily, or doxycycline 200 mg on day 1 followed by 100 mg daily, or 200 mg daily. Patients with inadequate response to the initial treatment were crossed over to the alternative antibiotic. Both regimens proved equally efficacious, with rates of clinical response (cure or improvement) of 89% and 91% for doxycycline and co-amoxiclav, respectively. Patients who were crossed over to the alternative antibiotic had a significantly lower cure rate after their second course of antibiotics (22% compared with 70%). Adverse effects, most often of gastro-intestinal, were more common in the co-amoxiclav group, but rarely caused cessation of treatment.

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Further reading

References
  • 1. McCarty JM, Phillips A, Wiisanen R. Comparative safety and efficacy of clarithromycin and amoxicillin/clavulanate in the treatment of acute otitis media in children. Pediatr Infect Dis J. 1993 Dec;12(12 Suppl 3):S122-7. PubMed
  • 2. Anzueto A, Fisher CL Jr, Busman T, Olson CA. Comparison of the efficacy of extended-release clarithromycin and amoxicillin/clavulanate in the treatment of acute exacerbation of chronic bronchitis. Clin Ther. 2001 Jan;23(1):72-86. PubMed
  • 3. Riffer E, Spiller J, Palmer R, Shortridge V, Busman TA, Valdes J. Once daily clarithromycin extended-release vs twice-daily amoxicillin/clavulanate in patients with acute bacterial sinusitis: a randomized, investigator-blinded study. Curr Med Res Opin. 2005 Jan;21(1):61-70. PubMed
  • 4. Rechtweg JS, Moinuddin R, Houser SM, Mamikoglu B, Corey JP. Quality of life in treatment of acute rhinosinusitis with clarithromycin and amoxicillin/clavulanate. Laryngoscope. 2004 May;114(5):806-10. PubMed
  • 5. Grossman RF, Ambrusz ME, Fisher AC, Khashab MM, Kahn JB. Levofloxacin 750 mg QD for five days versus amoxicillin/clavulanate 875 mg/125 mg BID for ten days for treatment of acute bacterial exacerbation of chronic bronchitis. Clin Ther. 2006 Aug;28(8):1175-80. PubMed
  • 6. Jareoncharsri P, Bunnag C, Fooanant S, Tunsuriyawong P, Voraprayoon S, Srifuengfung S, Dhiraputra C. An open label, randomized comparative study of levofloxacin and amoxicillin/clavulanic acid in the treatment of purulent sinusitis. Rhinology. 2004 Mar;42(1):23-9. PubMed
  • 7. Noel GJ, Blumer JL, Pichichero ME, Hedrick JA, Schwartz RH, Balis DA, Melkote R, Bagchi P, Arguedas A. A randomized comparative study of levofloxacin versus amoxicillin/clavulanate for treatment of infants and young children with recurrent or persistent acute otitis media. Pediatr Infect Dis J. 2008 Jun;27(6):483-9. PubMed
  • 8. Pessey JJ, Gehanno P, Thoroddsen E, Dagan R, Leibovitz E, Machac J, Pimentel JM, Marr C, Leblanc F. Short course therapy with cefuroxime axetil for acute otitis media: results of a randomized multicenter comparison with amoxicillin/clavulanate. Pediatr Infect Dis J. 1999 Oct;18(10):854-9. PubMed
  • 9. Gooch WM 3rd, Blair E, Puopolo A, Paster Z, Schwartz RH, Miller HC, Smyre HL, Giguere GC, Collins JJ. Clinical comparison of cefuroxime axetil suspension and amoxicillin/clavulanate suspension in the treatment of pediatric patients with acute otitis media with effusion. Clin Ther. 1995 Sep-Oct;17(5):838-51. PubMed
  • 10. Henry D, Ruoff GE, Rhudy J, Puopolo A, Drehobl M, Schoenberger J, Giguere G, Collins JJ. Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with secondary bacterial infections of acute bronchitis. Clin Ther. 1995 Sep-Oct;17(5):861-74. PubMed
  • 11. Higuera F, Hidalgo H, Feris J, Giguere G, Collins JJ. Comparison of cefuroxime axetil and amoxycillin/clavulanate in the treatment of community-acquired pneumonia. J Antimicrob Chemother. 1996 Mar;37(3):555-64. PubMed
  • 12. Camacho AE, Cobo R, Otte J, Spector SL, Lerner CJ, Garrison NA, Miniti A, Mydlow PK, Giguere GC, Collins JJ. Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with acute bacterial maxillary sinusitis. Am J Med. 1992 Sep;93(3):271-6. PubMed
  • 13. Sternon J. Open randomized study comparing doxycycline and co-amoxiclav in the treatment of acute suppurative tracheobronchitis in adults. The Collaborative Group of the Centre Universitaire de Medecine Generale de L'Universite Libre de Bruxelles (CUMG-ULB) Investigators. J Int Med Res. 1995 Sep-Oct;23(5):369-76. PubMed
  • 14. Casey JR, Block SL, Hedrick J, Almudevar A, Pichichero ME. Comparison of amoxicillin/clavulanic acid high dose with cefdinir in the treatment of acute otitis media. Drugs. 2012 Oct 22;72(15):1991-7

Published: March 31, 2008
Last updated: February 14, 2017

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