Letter Re: Stocking Up on Augmentin–the Antibiotic of Choice

Jim:
I’m somewhat reluctant to offer blanket medical advice to non-patients, but after reading SF in Hawaii’s comments about Augmentin (Amoxicillin-clavulanate) bears comment.
There is no ‘one best antibiotic’ for all purposes. Antibiotics have to be administered based on the specific type of bacteria causing an infection. Administering the wrong antibiotic doesn’t just not work, it causes bacteria that are not killed outright to become resistant to it – which can cause problems down the road. People have pathogenic bacteria in and on them all the time, when something causes them to go out of balance and cause disease. At the very basic level, antibiotics are based on the cell wall of the bacteria (which determines if it will stain pink or blue with the Gram microscopic stain process). Once that determination is made, certain bacteria are sensitive to certain drugs.
If I were to recommend a basic armamentarium of oral antibiotics, I’d have to pick at least 5 different ones. I actually carry these, plus another drug, gatifloxacin that is no longer available in the US, plus 4 or 5 intravenous/intramuscular (IV/IM) [injectable] drugs, and pick the best drug for the problem at hand:
1. Ciprofloxacin (Cipro) 500mg twice a day for infectious (bacterial) diarrhea (5 days max), anthrax prophylaxis (x60 days), uncomplicated urinary tract infection (UTI) (7 days max), gonorrhea (1-2 tabs, once)
Given the incidence of certain bacteria that are resistant to ciprofloxacin, it is also wise now to also carry azithromycin
2. Azithromycin 250mg Comes in packs of 6 for 5 days dosage, take 2 the first day, then 1 a day until gone, for bronchitis, pneumonia, or serious throat infection.
3. Ampicillin 500 mg 4 times a day for , or amoxicillin-clavulanate 875 mg twice a day (Augmentin, very expensive) for sinus infection, skin infection, or ear infection, gastro-intestinal (GI), or genitourinary (GU)
4. Trimethoprim-sulfamethoxazole 160/800mg (double strength) twice a day, 7-10 days or doxycycline 100 mg twice a day, for 7 days for methicillin-resistant Staphylococcus aureus (MRSA) infection, UTI, otitis media, sinusitis, bronchitis
Doxycycline is also a chloroquine-resistant malaria prophylaxis, take 1 daily starting 2 days before travel until 4 weeks (28 days) after return from endemic area, effective against Rickettsials (Rocky Mountain spotted fever)
5. Metronidazole 500mg 4 times a day for 7-14 days effective against Giardia lamblia and for dental infections, trichomoniasis

Augmentin is very good for animal (especially cat) bites, but it is quite expensive. Amoxicillin is a synthetic penicillin, the clavulinic acid (clavulanate) contributes penicillinase (an enzyme some bacteria produce that inhibits penicillin effectiveness) resistance.
This list is in no way comprehensive, nor are the indications the only possible uses for the drug, or the only drug for a condition.
Take care, and keep up the good work. – Flighter, MD