Clavulanic acid combination therapy

Kern WV, Marchetti O, Drgona L, Akan H, Aoun M, Akova M, et al. Oral antibiotics for fever in low-risk neutropenic patients with cancer a double-blind, randomized, multicenter trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxiciUin/clavulanic acid combination therapy-EORTC infectious diseases group trial XV. J Clin Oncol 2013 31(9) 1149-56. 

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. 

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. 

Broad spectrum therapy is started on an empirical basis. Intra-abdominal infections can be treated by ampicillin (or amoxycillin) or clindamycin combined with aminoglycosides, penicillin-beta-lacta-mase inhibitors such as amoxycillin-clavulanic acid or a second or third generation cephalosporin combined with metronidazole are good alternatives. In patients with impaired immunity and/or prior use of antibiotics, i.e. when it is reasonable to expect resistant pathogens, a broad spectrum penicillin plus beta-lactamase inhibitor or a carbapenem can be used empirically in monotherapy. In septic patients, the rapidly bactericidal action of aminoglycosides is useful. Aminoglycosides should preferentially not be given for more than 3-5 days. 

Augmentin is a combination therapy where the bacterial resistance to penicillins is reduced by the use of the [3-lactamase inhibitor clavulanic acid (20). It originated from Beechams and is now marketed by GlaxoSmithKline (GSK). 

The discovery of the naturally occurring, mechanism-based inhibitor clavulanic acid, which causes potent and progressive inactivation of lactamases (Fig. I(M). has created renewed interest in /3-lactam combination therapy. This in-Krest has led to the design and synthesis of additional mechanism-based lactamase inhibitors, such as sulbactam and luobaciam. and the isolation of naturally occurring lactams. such as the thienamycins, which both inhibit /S-lacta-nuses and interact with PBPs. 

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. 

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