Augmentin (Co-amoxiclav)
Generic Name: Amoxicillin/Clavulanic acid
Brand Names: Augmentin, Amoclan, Co-amoxiclav, Clavamox
Augmentin uses
Co-amoxiclav is a beta-lactam antibacterial co-formulated with a beta-lactamase inhibitor. Addition of clavulanic acid in Co-amoxiclav enhances its effectiveness against many resistant bacteria. It is active against many beta-lactamase producing strains of S. aureus, H. influenzae, N. gonorrhoeae, E. coli, M. catarrhalis and Proteus, Klebsiella and Bacteroides species.
Amoxicillin clavulanate is appropriate for second-line use in acute pyelonephritis because it has good kidney penetration and covers the broad range of bacteria that may cause acute pyelonephritis.
Amoxicillin clavulanate is an appropriate antibacterial treatment for facial and periorbital cellulitis, animal bites, clenched fist injuries, subcutaneous abscess, and severe dental abscess with spreading cellulitis.
Amoxicillin clavulanate is appropriate for second-line use in persistent sinusitis because it has good activity against anaerobes and also H. influenza, Streptococcus pneumoniae and M. catarrhalis.
Augmentin in mastitis
Mastitis is an inflammation of the breast. It occurs in about 10 percent of breastfeeding mothers.
Co-amoxiclav is used to treat lactational mastitis as well as mastitis in non-lactating women. S. aureus is usually the cause of mastitis in lactating women. Anaerobes are the most common bacteria implicated in non-puerperal mastitis (particularly in sub-areolar mastitis) which occur in non-lactating women.
The dosage for Augmentin for mastitis is 875 mg twice daily.
Augmentin dosage:
Note: Dose is based on the amoxicillin component.
Usual dosage range:
- Infants < 3 months: 30 mg/kg/day divided every 12 hours using the 125 mg/5 mL suspension
- Children >=3 months and < 40 kg: 20-90 mg/kg/day divided every 8-12 hours
- Children >40 kg and Adults: 250-500 mg every 8 hours or 875 mg every 12 hours
Children >=3 months and < 40 kg
- Severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8
hours
- Mild-to-moderate infections: 25 mg/kg/day divided every 12
hours or 20 mg/kg/day divided every 8 hours
Children >=16 years and Adults:
- Bite wounds (animal/human): 875 mg every 12 hours or 500 mg every 8 hours
- Chronic obstructive pulmonary disease: 875 mg every 12 hours or 500 mg every 8 hours
- Erysipelas: 875 mg every 12 hours or 500 mg every 8 hours
- Pyelonephritis (acute, uncomplicated): 875 mg every 12 hours or 500 mg every 8 hours
- Skin abscess: 875 mg every 12 hours
Augmentin side effects:
The most frequent side effects are diarrhea or loose stools (9%); nausea (3%);
vomiting (1%); and vaginitis (1%).
Augmentin is known to cause hypersensitivity reaction in up to 10% of patients, and may present as skin rashes, urticaria, angioedema, pruritus, and exfoliative dermatitis. Amoxicillin rashes occur more frequently in patients with unrecognized infectious mononucleosis.
Precautions:
Contraindicated in patients with a history of allergic reactions
to penicillins. It is also contraindicated in patients with a previous
history of cholestatic jaundice/hepatic dysfunction associated with Augmentin.
- Hepatitis and cholestatic jaundice: Although rare, transient hepatitis and cholestatic jaundice have been reported with amoxicillin/clavulanate. It occurs more frequently with prolonged
use of Co-amoxiclav, in elderly and males. It may occur during therapy or up to six weeks afterwards.
- Anaphylactoid/hypersensitivity reactions: Serious and occasionally
severe or fatal hypersensitivity (anaphylactoid) reactions have been
reported in patients on Co-amoxiclav, especially with a history
of beta-lactam hypersensitivity, history of sensitivity to multiple
allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema,
urticaria). Use with caution in asthmatics. Low incidence of
cross-allergy with cephalosporins exists.
- Infectious mononucleosis: Co-amoxiclav should
not be administered in setting of mononucleosis because of great likelihood of rash.
- Superinfection: Prolonged use may result in fungal or bacterial
superinfection, including C. difficile-associated diarrhea and pseudomembranous colitis.
- Renal dysfunction: Dosage adjustment is recommended in patients with renal impairment.
Possible interactions
- Allopurinol: Concomitant use of allopurinol can increase the likelihood of allergic skin reactions.
- Aminoglycosides: May be synergistic against selected organisms.
- Methotrexate: Augmentin may increase the exposure to methotrexate
during concurrent therapy; monitor.
- Probenecid: May increase levels of Augmentin; concomitant use not recommended.
- Warfarin: Effects of warfarin may be increased.
Laboratory Test Interactions:
May cause false-positive urine glucose test results with Benedict solution,
Fehling solution, or Clinitest tablets (enzyme-based tests [eg, Clinistix
, Tes-Tape ] are recommended); false-positive direct Coombs test result
in certain patient groups; false-positive protein reactions with sulfosalicylic
acid and boiling test, acetic acid test, biuret reaction, and nitric acid
test (Bromphenol Blue Test , Multi-Stix is recommended).
Pregnancy & Lactation:
Pregnancy Risk Factor: B
Both Co-amoxiclav components cross the human placenta. Teratogenic
effects have not been reported. Use in women with premature rupture of
fetal membranes may increase risk of necrotizing enterocolitis in neonates.
Breast-Feeding:
Augmentin is excreted in the milk; therefore, caution
should be exercised when administered to a nursing woman.
Overdose:
Symptoms of overdose may include abdominal cramps, diarrhea, drowsiness,
rash, hyperactivity, and vomiting. Interstitial nephritis
and/or crystalluria, possibly resulting in renal failure, may occur; hydration
and diuresis may be beneficial.
References:
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