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Amoxicillin-clavulanate: Recommended by current major guidelines for a wide range of bacterial infections

Choose the confidence of guideline-recommended antibiotic, to lead the fight against antimicrobial resistance and prevent recurrence of common bacterial infections.

Amoxicillin-clavulanate is listed as an ‘Access’
antibiotic by the World Health Organization (WHO)1

Click on an indication

to find out more about the guidelines recommending amoxicillin-clavulanate in the following indications:

 

  • Acute Otitis Media (AOM)

    First-line treatment

    isp_2019

    Severe/recurrent disease

    In case of otorrhoea or purulent conjunctivitis

    High amoxicillin dose (90 mg/kg/day) recommended

    aap_guidelines_2013

    May be considered for children who have received amoxicillin in the past 30 days; or

    In children with otitis-conjunctivitis syndrome, or

    If coverage is needed for H. influenzae or M. catarrhalis

    systematic_review_of_eu_guidelines_2019

    Recommended in case of primary treatment failure
    >70% of national guidelines

     

    ISP: Italian Society of Pediatrics; AAP: American Academy of Pediatrics; EU: European Union.

  • Acute Bacterial Rhinosinusitis (ABRS)

    First-line treatment

    aao_hns_clinical_practice_guideline_2015

    First-line therapy for most adults in cases of likely bacterial resistance, moderate to severe infection, comorbidities and age >65 years

    who_eml_guidance_2021

    First-line treatment option in acute bacterial sinusitis

    who_eml_guidance_2021

    First-line treatment in suspected ABRS

    abrs_idsa_clinical_practice_2012

    Initial empiric antimicrobial therapy in adults and children

     

    AAO-HNS: American Academy of Otolaryngology - Head and Neck Surgery; WHO EML: World Health Organization Essential Medicines List; IDSA: Infectious Diseases Society of America; ICAR-RS: International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.

  • Recurrent Tonsillopharyngitis

    recurrent_tonsillopharyngitis_idsa_clinical_practice_2012

    Recommended for eradication of group A Streptococci chronic carriage when appropriate*

    Treatment duration should be sufficient for bacterial eradication (typically 10 days)

    systematic_review_2018

    Drug of choice for recurrent acute tonsillopharyngitis

     

    *Appropriate situations include community outbreak of acute rheumatic fever, acute post streptococcal glomerulonephritis, invasive group A Streptococci (GAS) infection,
    GAS pharyngitis; history of acute rheumatic fever; excessive GAS infection anxiety; or tonsillectomy considered due to carriage.7

  • Community-Acquired Pneumonia (CAP)

    Adult patients1,9-11:

    Preferred empiric treatment

    bts_adults_2009

    For severe CAP (hospitalised), in combination with clarithromycin

    First choice

    cap_nice_2019

    For severe CAP, in combination with clarithromycin or erythromycin (in pregnancy)

    who_eml_2021

    Severe infections

    Recommended

    ats_and_idsa_2019

    For outpatient adults with comorbidities (in combination with macrolides or doxycycline)

    BTS: British Thoracic Society; NICE: National Institute for Health and Care Excellence; ATS: American Thoracic Society; IDSA: Infectious Diseases Society of America; WHO EML: World Health Organization Essential Medicines List.

    Paediatric patients10,12,13:

    bts_children_2011

    An alternative empirical therapy to amoxicillin for bacterial CAP 
    (mild-moderate)

    bts_children_2011

    An alternative to first choice drug (amoxicillin)

    cap_nice_2019

    For severe CAP, recommended as first choice

    If atypical pathogen is suspected, in combination with clarithromycin or erythromycin

    BTS: British Thoracic Society; IDSA: Infectious Diseases Society of America; NICE: National Institute for Health and Care Excellence; 
    PIDS: Pediatric Infectious Diseases Society.

  • Acute Exacerbations of COPD (AE COPD)

    First-line treatment

    who_eml_2021

    For exacerbations of COPD

    Initial empirical treatment

    gold_2023

    Aminopenicillin and clavulanic acid, macrolide or tetracyline in patients with frequent exacerbations or severe airflow limitations

       

    ae_copd_nice_2018

    Recommended as an alternative choice oral antibiotics (if person at higher risk of treatment failure; guided by susceptibilities when available)

    Recommended as second choice antibiotic (if no improvement in symptoms on first choice antibiotic taken for at least 2 to 3 days; guided by susceptibilities when available)

    GOLD: Global Initiative for Chronic Obstructive Lung Disease; NICE: National Institute for Health and Care Excellence; WHO EML: World Health Organization Essential Medicines List.

    For patients with moderate to severe exacerbations, GOLD 2023 guidelines recommend14:

    • Treatment based on local bacterial resistance pattern
    • Overall, 5-7 days of antibiotic therapy
    • For outpatients with COPD exacerbations, ≤5 days of antibiotic treatment is recommended

  • Skin and Soft Tissue Infections (SSTI)

    Primary therapy

    idsa_2014

    Option for impetigo and cellulitis

    Empiric treatment

    idsa_2012

    Option for mild DFI 
    (usually treated with oral agents)

    First-choice antibiotic

    ssti_nice_2019

    For cellulitis and erysipelas, if infection is near the eyes or nose

    Alternative choice antibiotic for severe infection

    DFI: Diabetic Foot Infection; IDSA: Infectious Diseases Society of America; NICE: National Institute for Health and Care Excellence.

 

 

Amoxicillin-clavulanate is listed as an ‘Access’ antibiotic by the WHO AWaRe classification1


 

Access

Watch

Reserve
Amoxicillin-clavulanate
Amoxicillin
Ampicillin*

 		 Azithromycin
Cefuroxime
Cefixime
Ceftriaxone
Levofloxacin*		 Levofloxacin*
Ceftazidime-avibactam
Linezolid*

 
1st/2nd empirical option for select infections† 1st/2nd empirical option for select infections† Reserved for treatment of confirmed or suspected multi-drug resistant infections
Lower resistance potential and effectiveness against common pathogens Higher resistance potential

 		 Effective against ‘Critical Priority’ or ‘High Priority’ pathogens
 
Widely available, affordable and quality-assured
 		 Should be prioritised in antibiotic stewardship and monitoring programs Last resort option in specific cases

 

ABRS: Acute Bacterial Rhinosinusitis; AE COPD: Acute Exacerbation of Chronic Obstructive Pulmonary Disease; AOM: Acute Otitis Media; AWaRe: Access, Watch and Reserve; CAP: Community-Acquired Pneumonia; SSTI: Skin and Soft Tissue Infections; WHO: World Health Organization.

*Only select antibiotics shown. For full list of Access, Watch and Reserve antibiotics, refer to the 22nd WHO Essential Medicines List, 2021.1
†Indications include ABRS, AE COPD, AOM, CAP, and SSTI.

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Prescribing Information

References

  1. World Health Organization. 22nd WHO Essential Medicines List, 2021. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02. Last accessed 22 November 2022.
  2. Marchisio P, Galli L, Bortone B, et al. Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment. Pediatr Infect Dis J 2019;38(12S Suppl):S10-S21.
  3. Lieberthal A, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964-e999.
  4. Suzuki HG, Dewez JE, Nijman RG, et al. Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines. BMJ Open 2020;10:e035343.
  5. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015;152(Suppl 2):S1–S39.
  6. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012;54(8):e72–e112.
  7. Shulman ST, Bisno AL, Clegg HW, et al. Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012;55(10):e86–e102.
  8. Munck H, Jørgensen AW, Klug TE. Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review. Eur J Clin Microbiol Infect Dis 2018;37(7):1221-1230.
  9. Lim WS, Baudouin SV, George RC, et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64 Suppl 3:iii1-55.
  10. Pneumonia (community acquired): antimicrobial prescribing. NICE guideline. 16 September 2019. Available from: https://www.nice.org.uk/guidance/ng138/resources/pneumonia-communityacquiredantimicrobialprescribing-pdf-66141726069445. Last accessed 22 November 2022.
  11. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia.  An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019;200(7):e45-e67.
  12. Bradley JS, Byington CL, Shah SS, et al. Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53(7):e25-76.
  13. Harris M, Clark J, Coote N, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011;66 Suppl 2:ii1-23. 
  14. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease. Available from: https://goldcopd.org/2023-gold-report-2/. Last accessed 22 November 2022.
  15. Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing. National Institute for Health and Care Excellence. Available from: https://www.nice.org.uk/guidance/ng114/resources/chronic-obstructive-pulmonary-disease-acuteexacerbation-antimicrobial-prescribing-pdf-66141598418629. Last accessed 23 December 2022.
  16. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59(2):e10–e52.
  17. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54(12):132–173.
  18. Cellulitis and erysipelas: antimicrobial prescribing. NICE guideline. 27 September 2019. Available from: https://www.nice.org.uk/guidance/ng141/resources/cellulitis-and-erysipelas-antimicrobial-prescribingpdf-66141774778309. Last accessed 22 November 2022.
  19. Orlandi RR;Int Forum Allergy Rhinol;2021;2021;11;213-739

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Augmentin is a registered trademark of the GlaxoSmithKline group of companies.

PM-RCH-ACA-WCNT-230005 | Approval date: January 2024. Expiration date: January 2026