July 29, 2023

Use of Combination of Broad Spectrum Antibiotics as Empirical Therapy in Management of Respiratory Tract Infections

Respiratory tract infections are the most common diagnosis irrespective of the age and gender and if not treated properly can lead to further complications. In Upper respiratory tract infections, the role of antibiotics is recommended only for Bacterial infections and if patient has fever and or purulent secretions. Most of the times, single antibiotics like Levofloxacin, Azithromycine, Cefuroxime should suffice the purpose.

In Lower respiratory tract infection as well, the antibiotics mentioned above should work in majority of the cases, except in high-risk individuals like in COPD, Bronchiectasis or long standing suppurative lung infections and in patients with recent hospitalisation or recurrent hospitalisations. In these individuals, due to high risk of colonisation due to resistant germs like Pseudomonas, Klebsiella, MRSA, E.Coli and candida, the need for combination of antibiotics will always be there.

In such individuals, it’s always a wise decision to start combination of broad spectrum antibiotics empirically before culture report is available. One such ideal combination is Amoxycillin plus clavulinic acid or Ampicillin and Sulbactam. These antibiotics show synergy when combined with each other and the coverage extends to further resistant organisms. Combinations of cephalosporin like cefuroxime or cefpodoxime along with levofloaxcin or macrolides like azithromycine or clarithromycine act better in suspected Atypical infections like Chlamydia and Mycoplasma. Similar exceptional case can be adding Linezolid orally in a patient suspected to have MRSA in sputum. I feel, these antibiotics must be in separate tablet or capsule form and needs specific dosing intervals. This can prevent the misuse and overuse of them.

However, there is no scientific data of adding clavulinic acid along with cephalosporins, as the synergistic effect is not proven. Also, adding any 2 or3 antibiotics in the same capsule without a clear advantage of synergy can affect the bioavailability of any of the products and further increasing the chance of antibiotic resistance. In a nutshell, the combination treatment is only for selected group of antibiotics and in pharmacologically proven drug combinations.