Clinical Tip No.10: No Need to Add Metronidazole

THE PROBLEM:

It’s not uncommon to see the combination of amoxicillin-clavulanate and metronidazole in practice.

THE BACKGROUND

Penicillin-penicillinase inhibitor combinations like amoxicillin-clavulanate and piperacillin-tazobactam already have excellent anaerobic coverage! They certainly do not need the addition of metronidazole.

Btw, is anaerobic coverage necessary in the first place? The need to cover the anaerobes is generally overemphasized among clinicians and it leads to the overuse of broad-spectrum antibiotics or nonsensical combinations like the one above.

 THE SOLUTION:

If you are already using amoxicillin-clavulanate or piperacillin-tazobactam, do NOT add metronidazole. It doesn’t add anything to the spectrum, and you just risk adverse events.