Amoxicillin/Clavulanate

General
  • Type: Amino-Penicillin
  • Dosage Forms: oral suspension, tablet, extended release tablet, chewable tablet
  • Dosage Strengths: oral suspension: (125/31.25mg)/5mL, (200mg/28.5mg)/5mL, (250mg/62.5mg)/5mL, (400mg/57mg)/5mL, (600mg/42.9mg)/5mL; tablet: 250mg/125mg, 500mg/125mg, 875mg/125mg; extended release tablet: 1000mg/62.5mg; chewable tablet: 200mg/28.5mg, 400mg/57mg
  • Routes of Administration: PO
  • Common Trade Names: Augmentin, Augmentin XR, Augmentin ES-600

Adult Dosing

Infection, Bacterial
  • 500mg-875mg PO q12h

Pneumonia, community-acquired
  • 2000mg ER PO q12h x 7-10 days

Pediatric Dosing

Infection, Bacterial
  • 25-45mg/kg PO divided q12h

Otitis media
  • 90mg/kg/day PO divided q12h x 10 days

Special Populations
  • Pregnancy risk: B
  • Lactation: probably safe
  • Renal Dosing
    • Adult: CrCl 10-30: give q12h, CrCl < 10, give q24h
    • Pediatric: CrCl 10-30: give q12h, CrCl < 10, give q24h
  • Hepatic Dosing
    • Adult: none
    • Pediatric: none

Contraindications
  • Allergy to class/drug

Adverse Reactions

Serious
  • anaphylaxis
  • steven johnson syndrome
  • c.diff associated diarrhea
  • hemolytic anemia
  • leukopenia
  • thrombocytopenia
  • hepatitis
  • seizures

Common
  • diarrhea
  • nausea
  • rash
  • pruritus
  • vomiting
  • glossitis
  • transaminitis

Pharmacology
  • Half-life: 1.1 hour
  • Metabolism: Liver
  • Excretion: urine
  • Mechanism of Action:Bactericidal, inhibits cell wall mucopeptide synthesis, inhibits beta lactamases

Antibiotic Sensitivities[1]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepI
Strep. anginosus gpS
Enterococcus faecalisS
Enterococcus faeciumS
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisR
C. jeikeiumR
L. monocytogenesX2
Gram NegativesN. gonorrhoeaeS
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negR
Enterobacter sp, AmpC posR
Serratia spR
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.I
Citrobacter freundiiR
Citrobacter diversusR
Citrobacter sp.R
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaI
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiS
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesS
Bacteroides fragilisS
Prevotella melaninogenicaS
Clostridium difficileX1
Clostridium (not difficile)S
Fusobacterium necrophorumS
Peptostreptococcus sp.S

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. Sanford Guide to Antimicrobial Therapy 2014
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