Antibiotics clavulanate

Oxidation of an allylic alcohol. This reagent has been used successfully to oxidize the benzyl ester of the /S-lactam antibiotic clavulanic acid (1) to the labile allylic aldehyde 2. Attempted oxidation with the Pfitzner-Moffatt reagent resulted in formation of a 1,3-diene by a 1,4-elimination. ... 

Biosynthesis of the 8-lactam antibiotic clavulanic acid begins with a TPP-dependent reaction between D-glyceraldehyde 3-phosphate and arginine. 

P-Lactams. AH 3-lactams are chemically characterized by having a 3-lactam ring. Substmcture groups are the penicillins, cephalosporias, carbapenems, monobactams, nocardicias, and clavulanic acid. Commercially this family is the most important group of antibiotics used to control bacterial infections. The 3-lactams act by inhibition of bacterial cell wall biosynthesis. 

Antibiotics, P-Lactams, Clavulanic Acid, Thienamycin, and Others," in ECT 3rd ed.. Supplement, pp. 83—131, by Allan Brown, Beecham Research Laboratories. 

Uncomplicated exacerbation Not requiring hospitalization Less than 3 exacerbations per year No comorbid illness I I V, greater than 50% predicted No recent antibiotic therapy Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Oral Macrolide (azithromycin, clarithromycin) Second- or third-generation cephalosporin (cefuroxime, cefpodoxime, cefdinir, cefprozil) Doxycycline Ketolide (telithromycin) P-Lactam/P-Iactamase inhibitor (amoxicillin-clavulanate) Intravenous Not recommended... 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

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 and amoxicillin-clavulanate are first-line antibiotics for acute otitis media. 

When combined with a (i-lactam antibiotic, both clavulanic acid and sulbactam provide very effective treatments for general bacterial infections, and overcome the resistance that would otherwise been encountered due to the expression of (i-lactamases. Clavulanic acid is sold in combination with the antibiotic amoxicillin and sulbactam is sold in combination with ampicillin. 

Lactams are a broad class of antibiotics that include penicillin derivatives, cephalosporins, monobactams, carbapenems, and clavams (/8-lactamase inhibitors). The metabolic engineering of penicillin and cephalosporins production has been summarized by several good reviews [71,72], so the focus here is clavulanic acid, which has attracted interest in recent years. 

In a recent study, the bacterial populations contaminating the upper gut in SIBO patients and their antibiotic susceptibility were determined. Amoxicillin-clavulanic acid and cefoxitin were effective against >90% of anaerobic strains, while aminopenicillins, cephalosporins and cotrimoxazole were effective against the microaerophilic population. Erythromycin, clindamycin and rifampicin were ineffective. Data on metronidazole and fluoroquinolones are not available [32]. 

Another recent controlled trial showed a good therapeutic effect of both amoxicillin-clavulanic acid and norfloxacin in SIBO patients [45]. However, a rapid relapse of diarrhea just few days after the withdrawal of antibiotics was evident. In this paper, the efficacy of probiotics in SIBO patients was also evaluated, but no significant effect was described. While on the one hand these results confirm the frequent need of several courses of antibiotic therapy in SIBO patients, on the other they support the idea that rifaximin may represent a good choice on the basis of its excellent tolerability. 

The answer is d. (Hardman, pp 1097—1098.) The antibiotic clavu-lanic acid is a potent inhibitor of p-lactamases. The mode of inhibition is irreversible. Although clavulanic acid does not effectively inhibit the transpeptidase, it maybe used in conjunction with a p-lactamase-sensitive penicillin to potentiate its activity... 

The role of antimicrobials for noninfected dog bite wounds remains controversial because only 20% of wounds become infected. Antibiotic recommendations for empiric treatment include a 3- to 5-day course of therapy. Amoxicillin-clavulanic acid is commonly recommended for oral outpatient therapy. Alternative agents include doxycycline, or the combination of penicillin VK and dicloxaciHin. 

Patients with noninfected bite injuries should be given prophylactic antibiotic therapy for 3 to 5 days. Amoxicillin-clavulanic acid (500 mg every 8 hours) is commonly recommended. Alternatives for penicillin-allergic patients include fluoroquinolones or trimethoprim-sulfamethoxazole in combination with clindamycin or metronidazole. First-generation cephalosporins, macrolides, clindamycin alone, or aminoglycosides are not recommended, as the sensitivity to E. corrodens is variable. 

The real breakthrough in identifying a -lactamase inhibitor came in 1976 with the isolation of a bicyclic -lactam, called clavulanic acid la (Fig. 3), produced by a strain of Streptomyces clavuligerus [21,22], In itself, this bicyclic -lactam is a weak antibiotic, but a powerful inhibitor of most class A en-... 

For localized disease with mild toxidty, the antibiotics should be administered as follows combine two of the above oral regimens for duration of thirty days, followed by monotherapy with either amoxicillin/clavulanate or TMP/sulfa for 60 to 150 days. 

Combinations of /3-lactamase inhibitors with /3-lactam antibiotics are very useful in the treatment of infections, since they are relatively immune to the emergence of new resistance. However, a /3-lactamase resistant to inactivation by clavulanic acid has been identified [52],... 

Transition metal ions cause a dramatic increase in the rate of hydrolysis of /Madam antibiotics [75][133][134], For example, copper(II) and zinc(II) ions increase the rate of alkaline hydrolysis ca. 108-fold and 104-fold, respectively [76], It has been suggested that the metal ion coordinates with both the carboxylate group and the /3-lactam N-atom of penicillins (A, Fig. 5.20). This complex stabilizes the tetrahedral intermediate and, thus, facilitates cleavage of the C-N bond catalyzed by the HO ion [74] [75], Such a model appears applicable also to clavulanic acid, imipenem, and monobactams, but it re-... 

Of particular note is the combination of amoxicillin and clavulanic acid. The latter is a potent inhibitor of enzymes that degrade amoxicillin and many other p-lactam antibiotics. This combination, marketed as Augmentin, increases the efficacy of amoxicillin against organisms that would be otherwise resistant to it. It is among the most widely used antibiotics in the United States. 

Timentin Antibiotic Inj 3.1 gm (ticarcillin 3 gm, clavulanic acid 0.1 gm) 3.1 gmlVq4-6h hypokalemia. 

---