Amoxicillin versus ...
- Amoxicillin vs Augmentin
- Amoxicillin vs Clarithromycin
- Amoxicillin vs Cefuroxime
- Amoxicillin vs Minocycline
- Amoxicillin vs Doxycycline
- Amoxicillin vs Penicillin
Recent Italian study5 found that skin reactions occur more frequently with amoxicillin than with amoxicillin/clavulanic acid. The incidence of gastrointestinal, hepatic and haematological side effects is significantly higher for amoxicillin/clavulanic acid. Also, Amoxicillin/clavulanic acid seems to be associated with a higher risk of Stevens-Johnson syndrome, purpura and hepatitis than amoxicillin alone.
Recurrent Otitis media
For recurrent otitis media (middle ear infection) amoxycillin/clavulanate for 7 days is comparable to amoxycillin for 10 days.
|Results of double-blind study14 with parallel groups of Amoxycillin/clavulanate versus amoxycillin forrecurrent otitis media.||Amoxicillin suspension (Imacillin)||Amoxicillin-
clavulanate suspension (Spektramox)
|Treatment results||More than 90% response|
|Treatment results after about 30 days after start of antibiotic therapy||Similar|
|Elimination of the initially occurring pathogens||Equal|
|Elimination of Branhamella catarrhalis||Significantly higher elimination rate|
Secretory Otitis media
Amoxicillin/clavulanate may have some advantages over amoxicillin in the treatment of otitis media with effusion (fluid in the middle ear, or "Glue ear").
|Results of comparative study of Augmentin and amoxicillin trihydrate for otitis media with effusion3.||Amoxicillin||Amoxicillin-
|Effusion free rate at day 10 following study entry||32%
(16 of 50 patients)
(29 of 56 patients)
|Effusion free rate at 4 weeks following study entry||51.1%
(23 of 45 patients)
(26 of 50 patients)
|Recurrence of effusion by the 16-week||63.2%
(12 of 19 patients)
(8 of 22 patients)
Respiratory tract infections (pneumonia, bronchitis, bronchiectasis)
Amoxicillin plus clavulanic acid is more effective than amoxicillin in the treatment of respiratory infections. Amoxicillin/clavulanic acid is superior to amoxicillin against strains of Branhamella catarrhalis, E. coli, coagulase-negative staphylococci and K. pneumoniae.
A Croatian study6 compared amoxicillin/clavulanic acid and amoxicillin in the treatment of respiratory tract infections. Leucocytosis and macroscopic purulence of sputum significantly improved with amoxicillin/clavulanate therapy while with amoxicillin there was no significant improvement. With respect to the presence of fever, there was no significant difference between two groups. The overall symptoms improvement and bacteriological response (eradication of bacteria) were very good and good in 88.5% of patients treated with amoxicillin/clavulanate compared to 75% of those receiving amoxicillin.
Both amoxicillin/clavulanate and amoxicillin are equally effective in the treatment of acute sinusitis.
|Results of double-blind, placebo-controlled study1 comparing the relative effectiveness of amoxicillin and Augmentin for acute maxillary sinusitis in children||Amoxicillin||Amoxicillin-
Clarithromycin and amoxicillin appears to have comparable effectiveness in the treatment of sinusitis7.
|Results of comparison of clarithromycin and amoxicillin in the treatment of acute maxillary sinusitis7.||Amoxicillin||Clarithromycin|
|Regimen||500 mg 3 times daily for 7 to 14 days||500 mg 2 times dailty for 7 to 14 days|
|Clinical success rate (based on direct observation of the patient)||89%||91%|
|Roentgenographic success rate||92%||78%|
|Adverse effects||mild gastrointestinal side effects|
Amoxicillin and clarithromycin are equally effective in the treatment of community-acquired pneumonia in children.
In a randomized clinical trial8 the mean hospital stay in patients treated with amoxicillin was 3.3 days and with clarithromycin was 3.2 days. Ninety-seven percent patients in both treatment groups achieved symptoms improvement.
Clarithromycin and amoxicillin are similarly effective in the treatment of acute ear infection (otitis media).
|Results of single blind, randomized, multicenter clinical trial2 comparing the safety and efficacy of clarithromycin and amoxicillin||Amoxicillin suspension||Clarithromycin suspension|
|Clinical success (cure and symptoms improvement) rates at 0 to 4 days posttreatment||90%||93%|
Erythema migrans (the rash characteristic of Lyme disease)
Clarithromycin works a little better than amoxicillin in the treatment of children with solitary erythema migrans.
|Results of comparative study16 of children with solitary erythema migrans||Amoxicillin||Clarithromycin|
|Average duration of erythema migrans after starting the antibiotic||4 days|
|Duration of Lyme borreliosis symptoms||10 day||7 days|
|Minor manifestations of Lyme borreliosis||16 of 54 patients
|11 of 50 patients
|Major manifestations of Lyme borreliosis||2 patients
Both amoxicillin and cefuroxime axetil are safe and effective for Lyme disease.
Randomized, unblinded study4 compared 2 regimens of cefuroxime axetil (20 mg/kg/d and 30 mg/kg/d) with amoxicillin (50 mg/kg/d), each given for 20 days. At the end of treatment, there was total resolution of erythema migrans in 67% of the amoxicillin group, 92% of cefuroxime group (20 mg/kg/d), and 87% of cefuroxime group (30 mg/kg/d), and resolution of constitutional symptoms occurred in 100%, 69%, and 87%, respectively. Mild diarrhea occurred in a small number of participants in each group (1 patient was diagnosed and treated for Clostridium difficile-associated diarrhea, which occurred after completing the full course). No hypersensitivity reactions occurred.
Both amoxicillin and cefuroxime are similarly effective in the improvement of bronchitis symptoms. However, amoxicillin therapy results in a significantly higher relapse rates.
In an investigator-blind, randomised, parallel group, multicentre study9 the two antibacterials had roughly similar efficacy:
|Results of investigator-blind, randomised, parallel group, multicentre study of amoxicillin and cefuroxime in the treatment of bronchitis9||Amoxicillin||Cefuroxime|
|Regimen||250 mg 3 times daily||250 mg 2 times daily|
|Clinical cure or improvement rate 24-72 hours after completion of the antibiotic treatment||80.4%
(123 of 153 patients)
(109 of 143 patients)
|Clinical relapses during the 4-week follow-up period following the end of treatment||20.8%
(16 of 77 patients)
(4 of 68 patients)
|Adverse events||mild and transient|
Cefuroxime axetil has comparable efficacy to amoxicillin in the treatment of children with middle ear infection and both are well tolerated.
In a multicentre general practice study10 of cefuroxime axetil suspension and amoxycillin syrup in the treatment of acute otitis media the overall cure or improvement rate was 94.3% for patients treated with cefuroxime axetil and 94.5% for those receiving amoxicillin. Some Streptococcus pneumoniae and Moraxella catarrhalis strains were resistant to amoxicillin.
Minocycline may be somewhat more effective than amoxicillin in the treatment of acute bacterial sinusitis.
In a comparative study15 after 11 days of antibacterial therapy, clinical cure or improvement and bacterial eradication were evident in 100% of the patients treated with minocycline and in 95% of the patients treated with amoxicillin. Roentgenographic results indicated clearing or improvement in 91% of the minocycline recipients and in 70% of amoxicillin recipients.
Lyme disease (Erythema migrans)
Amoxycillin plus probenecid and doxycycline for 21 days are equally effective for treatment of Lyme disease. Both antibacterials have in-vitro sensitivity of Borrelia burgdorferi, the necessary tissue penetration and pharmacokinetics.
In a randomised prospective study11 comparing amoxycillin/probenecid with doxycycline both regimens were equally effective for treatment of erythema migrans. Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months. None of the patients needed further antibacterial treatment for Lyme borreliosis.
Doxycycline and amoxicillin are equally effective for treating chlamydial and nonchlamydial cervicitis12.
|Results of randomized trial12 of doxycycline versus amoxicillin in the treatment of mucopurulent cervicitis||Amoxicillin||Doxycycline|
|Presence of endocervical mucopus after 2 months||18%|
|Presence of endocervical mucopus after 3 months||33%||23%|
Respiratory tract infections
Doxycycline seems to be superior to amoxicillin in respiratory tract infections.
Clinical observational study13 found statistically significant better response in those patients with acute and acute-on-chronic bronchitis who were treated with doxycycline. It is possible that this may have been related to a local upsurge in mycoplasma infection at the time of the study.
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Published: March 31, 2008
Last updated: February 09, 2017