Cefazolin antibiotic brands & uses
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Here is a complete overview of Cefazolin:
Cefazolin - Brands, Uses & Key Facts
Brand Names
| Brand | Region/Manufacturer |
|---|---|
| Ancef | US (most common) |
| Kefzol | US (legacy brand) |
| Zolicef | Various markets |
| Reflin | India/Asia |
| Cefacidal | Europe |
| Totacef | Italy |
| Cefamezin | Japan/Asia |
| Generic (cefazolin sodium) | Widely available worldwide |
Drug Class
First-generation cephalosporin (beta-lactam antibiotic) - parenteral only (IV/IM). It is the only first-generation parenteral cephalosporin still in general clinical use.
Mechanism of Action
Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking, leading to cell lysis.
Spectrum of Activity
| Organisms | Coverage |
|---|---|
| Gram-positive cocci | Excellent - Staphylococcus aureus (MSSA), Streptococcus spp. |
| Gram-negatives | Moderate - E. coli, Klebsiella pneumoniae, Proteus mirabilis |
| MRSA | No coverage |
| Anaerobes | Minimal/poor |
| CNS penetration | Poor - cannot treat meningitis |
Clinical Uses
1. Surgical Prophylaxis (Primary/Most Common Use)
Cefazolin is the drug of choice for perioperative antimicrobial prophylaxis across most surgical procedures:
- Cardiac surgery (coronary artery bypass, pacemaker implantation)
- Orthopedic surgery (joint replacement, fracture repair)
- Vascular surgery
- Abdominal/gastrointestinal surgery (clean and clean-contaminated wounds)
- Hernia repair
- Gynecologic and obstetric procedures
- Urologic procedures
- Neurosurgery
(Katzung's Basic and Clinical Pharmacology, 16th Ed.; Fischer's Mastery of Surgery, 8th Ed.; Schwartz's Principles of Surgery, 11th Ed.)
2. Skin & Soft Tissue Infections
- Cellulitis caused by streptococci/MSSA
- Wound infections
- Soft tissue abscesses (adjunct to drainage)
3. Bone & Joint Infections
- Osteomyelitis (MSSA)
- Septic arthritis
4. Respiratory Infections
- Community-acquired pneumonia (when caused by susceptible organisms)
5. Urinary Tract Infections
- UTIs caused by E. coli or Klebsiella (susceptibility must be confirmed)
6. Bacteremia/Endovascular Infections
- MSSA bacteremia (shown to be effective, better tolerated than antistaphylococcal penicillins like nafcillin)
- Endocarditis prophylaxis in high-risk patients (per AHA guidelines) - given as 1 g IM/IV 30-60 min before procedure
7. Penicillin-Allergic Patients
- Safe to use in patients with mild, non-immediate penicillin allergy (not anaphylaxis/urticaria)
Dosing (Adults)
| Indication | Dose |
|---|---|
| Mild-moderate infections | 0.5-1 g IV/IM every 8 hours |
| Severe infections | 1-2 g IV every 6-8 hours |
| Surgical prophylaxis | 1-2 g IV 30-60 min before incision; repeat if surgery >2 hours |
| Endocarditis prophylaxis | 1 g IM/IV once before procedure |
Peak serum level after 1 g IV infusion: ~185 mcg/mL. Dose adjustment required in renal impairment (CrCl <55 mL/min for perioperative use).
Pediatric: 25-50 mg/kg/day divided every 8 hours (up to 150 mg/kg/day for severe infections)
Key Pharmacokinetics
- Route: IV or IM only (not oral)
- Excretion: Renal (dose-adjust in renal failure)
- Half-life: ~1.8 hours
- Distribution: Good tissue penetration; poor CNS penetration
Important Limitations
- Does not cover MRSA
- Does not penetrate the CNS (cannot treat meningitis)
- Avoid in patients with immediate/severe penicillin hypersensitivity (anaphylaxis, urticaria) due to cross-reactivity risk
- Not effective against enterococci or Pseudomonas
Common Side Effects
- Injection site reactions (pain, phlebitis with IV)
- Gastrointestinal upset (nausea, diarrhea)
- Hypersensitivity reactions (rash, rarely anaphylaxis)
- C. difficile-associated diarrhea (uncommon but possible)
- Elevated liver enzymes (hepatotoxicity, rare)
Sources: Katzung's Basic and Clinical Pharmacology (16th Ed.), Fischer's Mastery of Surgery (8th Ed.), Schwartz's Principles of Surgery (11th Ed.), Sabiston Textbook of Surgery; WebMD - Cefazolin, Medscape - Cefazolin
Amoxyclav vs Cefuroxime Vs Cefodoxime vs Levoflox
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I now have comprehensive data from Katzung, Goodman & Gilman, and Murray & Nadel. Here is the full side-by-side comparison:
Amoxiclav vs Cefuroxime vs Cefpodoxime vs Levofloxacin - Full Comparison
At a Glance
| Feature | Amoxiclav (Co-amoxiclav) | Cefuroxime | Cefpodoxime | Levofloxacin |
|---|---|---|---|---|
| Class | Aminopenicillin + β-lactamase inhibitor | 2nd-gen cephalosporin | 3rd-gen cephalosporin | Fluoroquinolone (respiratory) |
| Brands | Augmentin, Clavamox, Clavam, Mox-CV | Ceftin (oral), Zinacef (IV), Stafurex | Vantin, Cepodem, Padagis | Levaquin, Tavanic, Levoday |
| Route | Oral / IV | Oral (axetil) / IV | Oral only | Oral / IV |
| Generation | - | 2nd | 3rd | - |
Spectrum of Activity
| Organism | Amoxiclav | Cefuroxime | Cefpodoxime | Levofloxacin |
|---|---|---|---|---|
| Streptococcus pneumoniae | ✅ Good | ✅ Good* | ✅ Good | ✅ Excellent |
| Streptococcus pyogenes (GAS) | ✅ Excellent | ✅ Good | ✅ Good | ✅ Good |
| MSSA | ✅ Good (clavulanate covers β-lactamase) | ✅ Good | ✅ Good | ✅ Moderate |
| MRSA | ❌ | ❌ | ❌ | ❌ |
| H. influenzae | ✅ Good (clavulanate covers β-lactamase producers) | ✅ Good | ✅ Good | ✅ Excellent |
| Moraxella catarrhalis | ✅ | ✅ | ✅ | ✅ |
| E. coli / Klebsiella | ✅ Moderate | ✅ Moderate | ✅ Good | ✅ Excellent |
| Pseudomonas aeruginosa | ❌ | ❌ | ❌ | ✅ Good (with Cipro > Levo) |
| B. fragilis (anaerobes) | ✅ Good | ❌ | ❌ | ❌ |
| Atypicals (Mycoplasma, Chlamydia, Legionella) | ❌ | ❌ | ❌ | ✅ Excellent |
| Enterococci | ✅ (amoxicillin component) | ❌ | ❌ | ❌ (poor) |
| ESBL-producing organisms | ❌ | ❌ | ❌ | Variable |
| Mycobacteria (TB/MAI) | ❌ | ❌ | ❌ | ✅ (MDR-TB regimens) |
* Cefuroxime is not predictably active against penicillin-non-susceptible pneumococci
Pharmacokinetics
| Parameter | Amoxiclav | Cefuroxime | Cefpodoxime | Levofloxacin |
|---|---|---|---|---|
| Oral bioavailability | ~90% (amoxicillin) | ~37-52% (axetil prodrug) | ~50% (proxetil prodrug) | ~95-99% |
| Effect of food | Not affected | Must take with food (esterase cleavage needed) | Must take with food | Not significantly affected |
| Half-life | ~1-1.3 hours | ~1.2 hours | ~2.2 hours | 5-7 hours (once daily) |
| CNS penetration | Poor | Poor (not for meningitis) | Poor | Good |
| Renal excretion | Yes (adjust in renal failure) | Yes | Yes | Yes (adjust if CrCl <50 mL/min) |
Standard Adult Doses (Oral)
| Drug | Dose | Frequency |
|---|---|---|
| Amoxiclav 500/125 mg | 500 mg amoxicillin + 125 mg clavulanate | Every 8 hours |
| Amoxiclav 875/125 mg | 875 mg amoxicillin + 125 mg clavulanate | Every 12 hours |
| Cefuroxime axetil | 250-500 mg | Twice daily |
| Cefpodoxime proxetil | 200-400 mg | Twice daily |
| Levofloxacin | 500 mg or 750 mg | Once daily |
Key Clinical Uses
| Indication | Amoxiclav | Cefuroxime | Cefpodoxime | Levofloxacin |
|---|---|---|---|---|
| Community-acquired pneumonia (CAP) | ✅ 1st-line (mild) | ✅ Alternative | ✅ Alternative | ✅ 1st-line (respiratory quinolone) |
| Sinusitis (acute bacterial) | ✅ 1st-line | ✅ Alternative | ✅ Alternative | ✅ Alternative |
| Otitis media (AOM) | ✅ 1st-line | ✅ Penicillin-allergic alternative | ✅ Penicillin-allergic alternative | Not preferred in children |
| Pharyngitis / Tonsillitis | ✅ | ✅ | ✅ | Avoid (reserved for resistant cases) |
| Acute bronchitis / AECOPD | ✅ | ✅ | ✅ | ✅ (preferred in severe/resistant) |
| Skin & soft tissue infections | ✅ (especially bite wounds, polymicrobial) | ✅ | ✅ | ✅ (diabetic foot) |
| UTI (uncomplicated) | ✅ | ✅ | ✅ | ✅ (3-day course) |
| Pyelonephritis | ✅ | Less preferred | Less preferred | ✅ (7-10 day course) |
| Intra-abdominal infections | ✅ (anaerobic cover) | ❌ | ❌ | ✅ + metronidazole |
| Animal/human bite wounds | ✅ Drug of choice | ❌ | ❌ | ❌ |
| Lyme disease (early) | ❌ | ✅ (cefuroxime axetil) | ❌ | ❌ |
| Gonorrhoea | ❌ | ❌ | ✅ Alternative | ✅ |
| MDR-TB / Atypical mycobacteria | ❌ | ❌ | ❌ | ✅ |
Adverse Effects
| Side Effect | Amoxiclav | Cefuroxime | Cefpodoxime | Levofloxacin |
|---|---|---|---|---|
| GI upset / Diarrhea | ✅ Common (clavulanate) | Mild | Mild | ✅ Moderate (3-17%) |
| Rash / Allergy | ✅ (penicillin allergy risk) | Low cross-reactivity | Low cross-reactivity | Low |
| C. difficile colitis | Moderate risk | Low risk | Low risk | ⚠️ High risk |
| Tendinopathy / Tendon rupture | ❌ | ❌ | ❌ | ⚠️ Black box warning (especially with steroids) |
| QT prolongation | ❌ | ❌ | ❌ | ⚠️ Yes |
| Photosensitivity | ❌ | ❌ | ❌ | ✅ |
| CNS effects (headache, insomnia, seizures) | ❌ | ❌ | ❌ | ✅ (1-11%) |
| Hepatotoxicity | ⚠️ Cholestatic jaundice (rare) | Rare | Rare | Rare |
| Peripheral neuropathy | ❌ | ❌ | ❌ | ⚠️ Yes |
Key Differences - When to Choose Which
| Clinical Scenario | Best Choice |
|---|---|
| CAP with atypical cover needed | Levofloxacin |
| CAP without atypical, mild/outpatient | Amoxiclav |
| Animal or human bite wound | Amoxiclav (anaerobic + aerobic cover) |
| Early Lyme disease | Cefuroxime axetil (or doxycycline) |
| Penicillin allergy, respiratory infection | Cefuroxime or Cefpodoxime (low cross-reactivity) |
| COPD exacerbation, severe or frequent exacerbator | Levofloxacin |
| Polymicrobial / mixed aerobic-anaerobic infection | Amoxiclav |
| UTI / pyelonephritis outpatient | Levofloxacin (or cefpodoxime) |
| Pelvic inflammatory disease | Amoxiclav (± metronidazole) |
| Avoid in tendon disorder / steroid use | Avoid Levofloxacin |
| Pregnancy | Amoxiclav preferred; avoid levofloxacin |
Contraindications / Precautions
| Drug | Key Warnings |
|---|---|
| Amoxiclav | Penicillin allergy; hepatic impairment (cholestatic hepatitis risk); adjust for CrCl <30 |
| Cefuroxime | Must take with food (oral); cross-allergy with penicillin ~1-2% |
| Cefpodoxime | Must take with food; antacids reduce absorption; renal dose adjust |
| Levofloxacin | Avoid in children/pregnancy (cartilage toxicity); QT prolongation; Black box: tendinopathy, CNS effects, peripheral neuropathy, aortic dissection risk; drug interactions (antacids reduce absorption - take 2 hrs apart) |
Sources: Katzung's Basic and Clinical Pharmacology (16th Ed.), Goodman & Gilman's Pharmacological Basis of Therapeutics, Murray & Nadel's Textbook of Respiratory Medicine, Harrison's Principles of Internal Medicine (22nd Ed.)
Amoxyclav 625 vs Amoxyclav 1000
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I now have all the information needed from the official GSK product information and medical textbooks. Here's the complete comparison:
Amoxiclav 625 vs Amoxiclav 1000
Composition - The Key Difference
| Amoxiclav 625 | Amoxiclav 1000 | |
|---|---|---|
| Amoxicillin | 500 mg | 875 mg |
| Clavulanic acid | 125 mg | 125 mg |
| Total tablet weight | 625 mg | ~1000 mg (≈1 g) |
| Amoxicillin : Clavulanate ratio | 4:1 | 7:1 |
| Frequency | Every 12 hours (BID) | Every 12 hours (BID) |
The clavulanate dose is identical (125 mg) in both - only the amoxicillin dose differs. The "625" and "1000" are just the combined weights of both components.
Why the Same Clavulanate?
Clavulanate's job is to inhibit beta-lactamases - a fixed 125 mg dose is sufficient for this purpose regardless of infection severity. Higher clavulanate does not improve outcomes and causes more GI side effects (diarrhea, nausea). So manufacturers keep it constant and increase only amoxicillin to achieve higher bactericidal concentrations.
Dosing Guidelines (Adults & Children >40 kg)
| Severity | Recommended Formulation | Dose |
|---|---|---|
| Mild to moderate infections | Amoxiclav 625 (500/125 mg) | 1 tablet every 12 hours |
| Severe infections | Amoxiclav 1000 (875/125 mg) | 1 tablet every 12 hours |
(Source: GSK Augmentin Official Product Information, Sept 2023)
When to Use Which
Amoxiclav 625 (500/125 mg) - Mild to Moderate
- Upper respiratory tract infections (sinusitis, tonsillitis, otitis media)
- Uncomplicated lower RTI / mild bronchitis
- Uncomplicated UTI / cystitis
- Mild skin & soft tissue infections (impetigo, cellulitis - early)
- Dental infections
- Step-down therapy after IV antibiotics
- Routine outpatient infections
Amoxiclav 1000 (875/125 mg) - Moderate to Severe
- Community-acquired pneumonia (CAP) - standard of care dose
- Severe sinusitis (especially with beta-lactamase-producing H. influenzae / M. catarrhalis)
- Complicated skin & soft tissue infections (bite wounds, diabetic foot - mild)
- Complicated UTI / pyelonephritis
- COPD acute exacerbations (moderate-severe)
- Intra-abdominal infections (mild community-acquired)
- Patients who need higher amoxicillin tissue concentrations
Renal Dose Adjustment
| CrCl | Use |
|---|---|
| >30 mL/min | Either 625 or 1000 mg is safe |
| 10-30 mL/min | Use 625 mg every 12 hrs only - 1000 mg is contraindicated |
| <10 mL/min | 625 mg every 24 hours |
| Haemodialysis | 625 mg every 24 hours + extra dose during/after dialysis |
Amoxiclav 1000 should NOT be used if CrCl <30 mL/min - switch to 625 mg.
Side Effects - Dose Dependent
| Side Effect | 625 mg | 1000 mg |
|---|---|---|
| Diarrhea | Less common | More common (higher amoxicillin load) |
| Nausea/vomiting | Mild | Slightly more |
| C. difficile colitis | Low | Low-moderate |
| Cholestatic hepatitis | Rare | Rare |
| Rash (penicillin allergy) | Same risk | Same risk |
Tip: Take both formulations with food to reduce GI side effects and improve absorption.
Quick Summary
| Feature | Amoxiclav 625 | Amoxiclav 1000 |
|---|---|---|
| Amoxicillin content | 500 mg | 875 mg |
| Clavulanate content | 125 mg (same) | 125 mg (same) |
| For | Mild-moderate infections | Moderate-severe infections |
| GI side effects | Less | More |
| Renal restriction | CrCl >10 mL/min | CrCl >30 mL/min |
| Frequency | BID (every 12h) | BID (every 12h) |
Bottom line: Both tablets are taken twice daily (BID). The only meaningful difference is the amoxicillin dose - 625 mg for routine/mild infections and 1000 mg when you need stronger bactericidal action for more serious infections. The clavulanate component (beta-lactamase inhibitor) stays at 125 mg in both.
Sources: GSK Augmentin Official Product Information (2023); Harriet Lane Handbook (23rd Ed.); Goodman & Gilman's Pharmacological Basis of Therapeutics; Medscape - Amoxicillin/Clavulanate
When to use amoxiclav vs other antibiotics for specific infections
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Excellent data gathered. Here is the complete infection-by-infection guide:
When to Use Amoxiclav vs Other Antibiotics
The Core Decision Rule
Use Amoxiclav when:
- Beta-lactamase-producing organisms are likely (H. influenzae, M. catarrhalis, S. aureus, Klebsiella, E. coli)
- Mixed aerobic + anaerobic infection is possible
- Initial amoxicillin has failed
- Bite wounds (any mammal)
Use a different antibiotic when:
- Atypical organisms are involved (Mycoplasma, Chlamydia, Legionella) - add/switch to macrolide or fluoroquinolone
- MRSA suspected - use clindamycin, TMP-SMX, doxycycline, or vancomycin
- Resistant gram-negatives / Pseudomonas - use fluoroquinolone, piperacillin-tazobactam, or carbapenem
- Penicillin allergy - use doxycycline, respiratory quinolone, or cephalosporin (if no anaphylaxis)
Infection-by-Infection Breakdown
1. Acute Otitis Media (AOM)
| Situation | Preferred | Why |
|---|---|---|
| First episode, no recent antibiotics | Amoxicillin (high-dose 80-90 mg/kg/day in children) | Most pneumococci still susceptible; lower GI side effects |
| Failed amoxicillin in 48-72h | Amoxiclav | Covers beta-lactamase-producing H. influenzae & M. catarrhalis |
| Severe AOM / bilateral / <2 years | Amoxiclav from the start | Higher risk of resistant organisms |
| Penicillin allergy | Cefdinir, cefpodoxime, or cefuroxime | Low cross-reactivity |
(Katzung; Tintinalli's Emergency Medicine)
2. Acute Bacterial Rhinosinusitis (Sinusitis)
| Situation | Preferred | Why |
|---|---|---|
| Mild, <10 days symptoms | Watchful waiting or amoxicillin | Most cases are viral; amoxicillin for bacterial |
| Moderate-severe, >10 days, or worsening | Amoxiclav 875/125 mg BID x 5-7 days | First-line per guidelines; covers beta-lactamase producers |
| Chronic sinusitis | Amoxiclav (first-line) | Polymicrobial including anaerobes |
| Beta-lactam allergy | Doxycycline or respiratory fluoroquinolone (levofloxacin/moxifloxacin) | - |
| Avoid | TMP-SMX, macrolides | High resistance rates |
(Washington Manual of Medical Therapeutics; Rosen's Emergency Medicine)
3. Community-Acquired Pneumonia (CAP)
| Situation | Preferred | Why |
|---|---|---|
| Outpatient, low risk, young, no comorbidities | Amoxicillin 1g TID alone | No atypical coverage needed if low risk |
| Outpatient, moderate risk / comorbidities | Amoxiclav 875/125 BID + azithromycin | Adds beta-lactamase coverage; azithromycin covers atypicals |
| Outpatient, single-drug option | Levofloxacin 750 mg OD | Covers pneumococcus + H. influenzae + atypicals in one drug |
| COPD patient with CAP | Amoxiclav or levofloxacin | Beta-lactamase producers common in COPD airways |
| Atypical pattern (young, dry cough, interstitial CXR) | Azithromycin or doxycycline alone | Mycoplasma/Chlamydia pneumoniae; beta-lactams have no effect on atypicals |
| Inpatient (non-ICU) | IV beta-lactam + azithromycin or fluoroquinolone alone | Broader inpatient coverage |
4. Pharyngitis / Tonsillitis
| Situation | Preferred | Why |
|---|---|---|
| Group A Strep (GAS) confirmed/suspected | Amoxicillin alone | GAS is NEVER beta-lactamase positive; amoxicillin is always active |
| Do NOT use Amoxiclav as first-line | - | No advantage over amoxicillin; extra cost and GI side effects |
| Penicillin allergy | Azithromycin (5-day) or cephalexin | - |
| Recurrent tonsillitis (suspected resistant GAS) | Amoxiclav | Covers beta-lactamase-producing oral flora that protects GAS |
5. Acute Bronchitis
| Situation | Preferred | Why |
|---|---|---|
| Acute bronchitis (typical) | No antibiotic | 90%+ viral; antibiotics do not help and cause resistance |
| AECOPD (mild-moderate) | Amoxiclav or doxycycline | Covers H. influenzae, M. catarrhalis, S. pneumoniae |
| AECOPD (severe / Pseudomonas risk) | Levofloxacin or ciprofloxacin | Ciprofloxacin/levofloxacin cover Pseudomonas |
6. Skin & Soft Tissue Infections (SSTIs)
| Situation | Preferred | Why |
|---|---|---|
| Simple cellulitis (no purulence) | Cephalexin or amoxicillin | Usually streptococcal; simpler, cheaper, fewer GI side effects |
| Cellulitis with purulence / abscess | TMP-SMX ± cephalexin | MRSA must be covered |
| Bite wounds - dog, cat, human | Amoxiclav - drug of choice | Polymicrobial: Pasteurella, streptococci, staph, anaerobes, Eikenella, Capnocytophaga |
| Diabetic foot (mild-moderate) | Amoxiclav | Mixed aerobic + anaerobic coverage |
| Diabetic foot (severe / MRSA risk) | Add clindamycin/vancomycin | Amoxiclav alone insufficient for MRSA |
| Water exposure (freshwater wound) | Fluoroquinolone or TMP-SMX | Covers Aeromonas |
| Saltwater wound | Fluoroquinolone or doxycycline | Covers Vibrio |
(Tintinalli's Emergency Medicine)
7. Urinary Tract Infections (UTIs)
| Situation | Preferred | Why |
|---|---|---|
| Uncomplicated cystitis (1st line) | Nitrofurantoin, fosfomycin, or TMP-SMX | Better cure rates, less resistance; amoxiclav is 3rd-line |
| Cystitis when 1st-line agents fail or are not tolerated | Amoxiclav 625 mg BID x 7 days | Covers beta-lactamase-producing E. coli when susceptibility confirmed |
| Pyelonephritis (outpatient) | Levofloxacin or ceftriaxone → oral step-down | Superior tissue penetration; amoxiclav has lower cure rates |
| UTI in pregnancy | Amoxiclav | Safe in pregnancy; nitrofurantoin avoided near term; fluoroquinolones contraindicated |
| Enterococcal UTI | Amoxicillin alone (no clavulanate needed) | Enterococci rarely produce beta-lactamase |
(Goodman & Gilman; Comprehensive Clinical Nephrology, 7th Ed.)
8. Dental / Oral Infections
| Situation | Preferred | Why |
|---|---|---|
| Dental abscess, pericoronitis | Amoxicillin alone (1st line) | Usually streptococcal/anaerobic; susceptible to amoxicillin |
| Failed amoxicillin / severe dental infection | Amoxiclav | Covers beta-lactamase-producing oral anaerobes |
| Penicillin allergy | Metronidazole + clindamycin | Anaerobic coverage |
9. Intra-abdominal Infections
| Situation | Preferred | Why |
|---|---|---|
| Mild community-acquired (diverticulitis, cholecystitis) | Amoxiclav | Covers gram-negatives + anaerobes; oral option available |
| Moderate-severe or hospital-acquired | Pip-tazo (IV) or ceftriaxone + metronidazole | Broader coverage; amoxiclav insufficient |
| Post-surgical / nosocomial | Meropenem or ertapenem | ESBL and resistant gram-negatives likely |
10. Specific Situations - DO NOT Use Amoxiclav
| Situation | Use Instead | Reason |
|---|---|---|
| MRSA infection | TMP-SMX, clindamycin, doxycycline, vancomycin | Amoxiclav has NO MRSA activity |
| Pseudomonas infection | Ciprofloxacin, pip-tazo, ceftazidime | Amoxiclav does not cover Pseudomonas |
| Atypical pneumonia (Mycoplasma, Legionella) | Azithromycin, doxycycline, levofloxacin | Beta-lactams have no cell wall target in atypicals |
| Meningitis | Ceftriaxone + vancomycin ± ampicillin | Amoxiclav penetrates CNS poorly |
| ESBL-producing organisms | Ertapenem, meropenem | Clavulanate does not reliably inhibit ESBLs |
| Viral upper respiratory tract infection | None | Antibiotics have no role |
| Simple GAS pharyngitis | Amoxicillin alone | Clavulanate adds nothing - GAS is never resistant |
Quick Reference Summary
AMOXICLAV = AMOXICILLIN + BETA-LACTAMASE INHIBITOR
USE AMOXICLAV WHEN: USE SOMETHING ELSE WHEN:
✅ Bite wounds (all mammals) ❌ MRSA → TMP-SMX / clindamycin
✅ Failed plain amoxicillin ❌ Atypicals → azithromycin / doxy
✅ Beta-lactamase producers ❌ Pseudomonas → cipro / pip-tazo
✅ Mixed aerobic+anaerobic ❌ Simple GAS pharyngitis → amox alone
✅ Moderate-severe sinusitis ❌ Uncomplicated UTI → nitrofurantoin
✅ CAP with comorbidities ❌ Meningitis → ceftriaxone + vancomycin
✅ UTI in pregnancy ❌ ESBL organisms → carbapenem
✅ Diabetic foot (mild) ❌ Acute bronchitis (viral) → no antibiotic
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Katzung's Basic and Clinical Pharmacology (16th Ed.); Washington Manual of Medical Therapeutics; Tintinalli's Emergency Medicine; StatPearls - Amoxicillin-Clavulanate
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