Amoxicillin-clavulanate dosing

The comorbid conditions that can affect therapy and outcomes in patients with CAP include diabetes mellitus, COPD, congestive heart failure, and renal failure.27,28 If the patient has not received antibiotics in the past 3 months, then clarithromycin or azithromycin is the recommended first-line therapy by the IDSA. If the patient has received antibiotics in the last 3 months, then the IDSA recommends using either a respiratory fluoroquinolone alone or a combination of an oral P-lactam and an advanced macrolide/azalide (e.g., clarithromycin/azithromydn). The ATS recommends combination therapy or monotherapy with a respiratory fluoroquinolone for all patients with comorbidities. The p-lactam agents recommended include high-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, and cefuroxime. 

Amoxicillin- clavulanate 80-90 mg/kg per day in 2-3 doses (adult 875 mg twice daily) Nausea, vomiting, diarrhea, rash, diaper rash J) J) J)— More diarrhea than amoxicillin, Augmentin ES formulation preferred owing to lower daily clavulanate component... 

Amoxicillin-clavulanate 1.75-4 g/day in 2-3 doses 90 mg/kg per day in 2 doses Broad coverage particularly with high doses Augmentin XR (2 g every 12 hours) targeted toward PRSP... 

A macrolide0 or doxycycline A respiratory fluoroquinolone0 alone, an advanced macrolide1 plus high-dose amoxicillin, or an advanced mac-rolide plus high-dose amoxicillin-clavulanate... 

Mild infection Amoxicillin-clavulanate 0.875 g orally every 12 hours Amoxicillin-clavulanic acid 20 mg/kg/day orally in three divided doses... 

Ulcus molle/chancroid is treated with a single dose of either ceftriaxone i.m. or with azithromycin 1 g orally. Three days of oral ciprofloxacin 2 x 500 mg daily or 7 days of amoxicillin/clavulanic acid 3 X 500/125 mg orally or erythromycin 4 x 500 mg orally are alternatives. 

Obstetric infections can be treated with penicillin-beta-lactamase inhibitors such as amoxicillin-clavulanic acid, with extended spectrum penicillins (with or without beta-lacamase inhibitors if justified by local resistance surveillance data), with a first or second generation cephalosporin combined with metronidazole. In severe cases of streptococcal infection high doses of penicillin in combination with clindamycin is the treatment of choice. In amnionitis, maternal morbidity resolves with delivery. In endometritis, antibiotics should be stopped after the... 

Amoxicillin component 80-90 m k day divided twice daily davulanatemmponent 6.4m k day. Amoxicillin-clavulanate 90 6.4 or 14 1 ratio IS available in the United States 7 1 ratio is available in Canada (usearroxidllin45rrigrkgforotTedose,arrioxidllin45rT kgwith clavulanate 6,4 mg kg for second dose). 

Amoxicillin clavulanic acid 40 nrrg/kg (of the amoxicillin component) in hvo divided doses... 

Amoxicillin-clavulanic acid 20 mjVksVday orally in three divided doses... 

Higher dose amoxicillin, amoxicillin-clavulanate (e.g., 90 mg/kg day) is used for penicillin resistant S. pneumoniae. 

No Amoxicillin usual dose 40-45 mg/kg/day Amoxicillin high dose 80-90 mg/kg/day (high-risk patients) Amoxicillin-clavulanate high dose Amoxicillin component 80-90 mg/kg/day clavulanate component 6.4 mg/kg/day Cefuroxime axetil Suspension 30 mg/kg/day divided twice daily (max 1 g) Tablets 250 mg twice daily Intramuscular ceftriaxone 1 g (50 mg/kg) daily for 3 days Same as day 3... 

Yes Amoxicillin high dose Intramuscular ceftriaxone Amoxicillin-clavulanate high dose ... 

Amoxicillin-clavulanate high dose Clindamycin - Cefuroxime axetil... 

Amoxicillin- clavulanate 500/125 mg three times daily 40-50 mg/kg/day divided in 3 doses High dose Can add 40-50 mg/kg/day amoxicillin... 

Amoxicillin-clavulanate 500 mg twice daily 40 mg/kg/day in 3 divided doses... 

If treatment failure occurs with amoxicillin, an agent should be chosen with activity against /1-lactamase-producing H. influenzae and M. catar-rhalis as well as drug-resistant S. pneumoniae (such as high-dose amoxicil-lin-clavulanate (recommended), or, cefuroxime, cefdinir, cefpodoxime, cefprozil, or intramuscular ceftriaxone). 

High-dose amoxicillin with clavulanate or /J-lactamase-stable cephalosporin. Second choice respiratory fluoroquinolone. 

Co-amoxiclav consists of the combination of amoxicillin (penicillin antibacterial agent) and clavulanic acid (beta-lactamase inhibitor) which is associated with a risk of crystalluria in patients with renal impairment who are receiving high doses, particularly during parenteral therapy. 

Lactamase Inhibitor] Uses Ear, lower resp, sinus, UTI, skin Infxns caused by i-lactamase-producing H. influenzae, S. aureus, E. coli Action Combo 3-lac-tam antibiotic i-lactamase inhibitor Dose Adults. 250-500 mg PO q8h or 875 mg ql2h XR 2000 mg PO ql2h Peds. 20-40 mg/kg/d as amoxicillin PO q8h or 45 mg/kg/d + ql2h X in renal impair take w/ food Caution [B, enters breast milk] Disp Tabs, chew tabs, susp SE Abd discomfort, N/V/D, allergic Rxn, vaginitis Notes Do not substitute two 250-mg tabs for one 500-mg tab (OD of clavulanic acid) max clavulanic acid 125 mg/dose Interactions T Effects OF warfarin, MTX,... 

Amoxicillin is well absorbed when given orally, with a bioavailability that appears to be much higher than expected in the light of its physico-chemical properties and the pH partition theory [191], Numerous studies show recovery of intact amoxicillin in urine after oral administration in the range 43 to 80 % after 6 to 8 hours, with most figures in the upper part of this range [147,171,172,187,188,190]. An additional 10 to 25 % of the dose appears in urine as the penicilloic acid [147,148,152,171,172,187] with a ratio of about 2 to 1 of the 5R to 5S isomers [152,171,172]. Amoxicillin is extensively distributed in body tissues and fluids, with adequate levels for antibacterial activity in most of them [187,188,190], The half life in serum is about one hour and is the same for oral, intramuscular and intravenous administration [187,188,190]. Co-administration with potassium clavulanate does not affect the absorption, distribution and excretion of amoxicillin [190]. 

Immediate-type hypersensitivity Clarithromycin or azithromycin or trimethoprim-sulfamethoxazole Non immediate-type hypersensitivity / -Lactamase-stable cephalosporin High-dose amoxicillin with clavulanate or / -lactamase-stable cephalosporin... 

For infected bite wounds, penicillin and a peniciUinase-resistant penicillin or amoxiciUin-clavulanic acid 875 mg/125 mg oraUy twice daily (40 mg/kg per day oraUy of the amoxicillin component divided into two doses) should be started empirically pending the culture results. Tetracyclines or a combination of clindamycin plus a fluoroquinolone or trimethoprim-sulfamethoxazole may be used as an alternative therapy for the penicillin-allergic patient. Hospitalization for minor wounds is not necessary if surgical repair of vital structures has not been performed. Patients suffering serious injuries or clenched-fist injuries should be started on intravenous antibiotics. Duration of therapy for infected bite injuries should be 7 to 14 days. 

Tu, Y.H. Stiles, M.L. Allen, L.V.J. Olsen, K.M. Barton, C.I. Greenwood, R.B. Stability of amoxicillin trihydrate-potassium clavulanate in original containers and unit dose oral s3ringes. Am.J. Hosp.Pharm., 1988, 45, 1092-1099... 

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