Augmentin (Amoxicillin/Clavulanate) versus ...
- Augmentin vs Clarithromycin
- Augmentin vs Cefuroxime
- Augmentin vs Cefdinir
- Augmentin vs Levofloxacin
- Augmentin vs Doxycycline
Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch
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.
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) |
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%).
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.
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.
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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Published: March 31, 2008
Last updated: February 14, 2017
