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Amoxicillin Clavulanate

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Amoxicillin Clavulanate, Augmentin

  • See Also
  1. Aminopenicillin
  2. Ampicillin
  3. Amoxicillin
  4. Unasyn
  • Indications
  1. Otitis Media
  2. Acute Bacterial Sinusitis
  3. Pneumonia
  4. Group A Streptococcal Pharyngitis
  5. Helicobacter Pylori
  6. Endocarditis Prophylaxis
  7. Skin and Soft Tissue Infections
  8. Urinary Tract Infection
  9. Dog Bite Infection
  • Contraindications
  1. Penicillin Allergy
    1. Cefadroxil and Cefprozil have similar side chains and risk of cross reactivity with Amoxicillin
  • Medications
  1. Amoxicillin Clavulanate Tablets (Augmentin) 500/125 and 875/125 mg
  2. Amoxicillin Clavulanate Extended Release Tablets (Augmentin XR) 1000/62.5 mg
  3. Amoxicillin Clavulanate Suspension 250/62.5 mg per 5 ml
    1. Stable in the refrigerator for 10 days
  4. Amoxicillin Clavulanate Suspension Extra Strength (Augmentin ES) 600/42.9 mg per 5 ml
    1. Only intended for high dose 90 mg/kg protocols (e.g. Otitis Media age <2 years)
    2. Reducing clavulanate dose decreases Diarrhea
  5. Amoxicillin Clavulanate Chewables 200/28.5 mg and 400/57 mg
  • Dosing
  1. Adult (or weight >40 kg)
    1. Standard: 875 to 1000 mg orally twice daily
    2. Augmentin XR: 2000 mg orally every 12 hours
  2. Child
    1. Typical Dose: 45 mg/kg/day divided orally twice daily
    2. Otitis Media (age <2 years): 90 mg/kg/day divided orally twice daily (use Augmentin ES)
  3. Renal Dosing (eGFR <30 ml/min)
    1. Reduced dosing and frequency if eGFR <30 ml/min
    2. Do NOT use Amoxicillin Clavulanate Extended Release Tablets (Augmentin XR) if eGFR <30 ml/min
  • Pharmacokinetics
  1. Keep Augmentin suspension refrigerated
  2. Clavulanate suspension breaks down at room Temperature
    1. Turns brown with breakdown
    2. Loses 90% of potency after 2 days at room Temperature
  • Mechanism
  1. See Aminopenicillin
  2. Clavulanate adds beta lactamase resistance to Amoxicillin
  • Adverse Effects
  1. See Aminopenicillin
  2. See Penicillin
  3. Maculopapular rash
    1. Onset 5-7 days after initiating medication
    2. Typically not IgE mediated (non-allergic)
      1. No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
    3. Typically safe to use Amoxicillin in future if non-allergic rash alone
      1. Consider IgE Skin Testing if unclear rash etiology
    4. References
      1. Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
  4. Diarrhea
    1. Most common with Augmentin
    2. Modifications can decrease stools
      1. Dose exactly by kilogram for children
      2. Avoid food before dose
      3. Consider eating yogurt with each dose
  • Safety
  1. Pregnancy Category B
  2. Safe in Lactation
  • Resources
  1. Amoxicillin Clavulanate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=963e7bea-ff5d-420a-9cb2-e4aefb534b33
  • References
  1. (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
  4. Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]