III. Contraindications

  1. Penicillin Allergy
    1. Cefadroxil and Cefprozil have similar side chains and risk of cross reactivity with Amoxicillin

IV. 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

V. 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

VI. 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

VII. Mechanism

  1. See Aminopenicillin
  2. Clavulanate adds beta lactamase resistance to Amoxicillin

VIII. 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
  5. Drug-Induced Enterocolitis Syndrome (DIES)
    1. See Amoxicillin

IX. Safety

  1. Pregnancy Category B
  2. Safe in Lactation

XI. References

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Related Studies

Ontology: Amoxicillin / Clavulanate (C0054066)

Definition (NCI) A combination of the semisynthetic broad-spectrum antibiotic amoxicillin and the beta-lactamase enzyme inhibitor clavulanate potassium. Clavulanate potassium increases the serum half-life of amoxicillin by inhibiting beta-lactamase-mediated metabolism of amoxicillin. Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin binding proteins and inhibiting peptidoglycan synthesis, a critical component of bacterial cell walls.
Definition (NCI) A fixed combination of Amoxicillin and Clavulanic Acid, which inhibits beta-lactamase, a bacterial enzyme that inactivates amoxicillin.
Definition (NCI_NCI-GLOSS) A drug used to treat bacterial infections. Adding the chemical clavulanate potassium to the antibiotic amoxicillin increases the amount of time the antibiotic stays active in the body. Amoxicillin-clavulanate potassium is a type of combination antibiotic.
Definition (MSH) A fixed-ratio combination of amoxicillin trihydrate and potassium clavulanate.
Definition (PDQ) A combination of the semisynthetic broad-spectrum antibiotic amoxicillin and the beta-lactamase enzyme inhibitor clavulanate potassium. Clavulanate potassium increases the serum half-life of amoxicillin by inhibiting beta-lactamase-mediated metabolism of amoxicillin. Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin binding proteins and inhibiting peptidoglycan synthesis, a critical component of bacterial cell walls. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40783&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40783&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1023" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D019980
SnomedCT 387514006, 89519005
LNC LP15420-0, MTHU006777
English Amox-clav, Amoxi Clavulanate, Amoxi-Clavulanate, Amoxicillin Potassium Clavulanate Combination, Amoxicillin-Potassium Clavulanate Combination, Amoxycillin, Clavulanate Potentiated, Clavulanate Potentiated Amoxycillin, Clavulanate-Amoxicillin Combination, Potassium, Combination, Potassium Clavulanate-Amoxicillin, Potassium Clavulanate Amoxicillin Combination, Potassium Clavulanate-Amoxicillin Combination, Potentiated Amoxycillin, Clavulanate, AMOXICILLIN/CLAVULANATE, Amox clav, amoxicillin-clavulanic acid, amoxicillin + clavulanic acid, amoxicillin + clavulanic acid (medication), amoxicillin-clavulanate, Amoxicillin-Potassium Clavulanate Combination [Chemical/Ingredient], Amoxicillin / Clavulanate, amox-clav, co amoxiclav, coamoxiclav, amoxycillin clavulanic acid, amox clav, acid amoxicillin clavulanic, acid amoxycillin clavulanic, amoxicillin with clavulanic acid, co-amoxiclav, amoxi-clavulanate, amoxicillin clavulanate, amoxicillin clavulanic acid, Amoxycillin with clavulanate potassium (substance), Amoxicillin+Clavulanate, Amoxicillin-Clavulanate, Amoxicillin with clavulanic acid, Amoxycillin with clavulanate potassium, Amoxycillin with clavulanate potassium (product), amoxicillin-clavulanate potassium, Co-amoxiclav, Amoxicillin Clavulanic Acid, Amoxicillin-Clavulanic Acid, Amoxycillin Clavulanic Acid, Amoxycillin-Clavulanic Acid, Co amoxiclav, Coamoxiclav, Amoxicillin-Clavulanate Potassium, Amoxicillin and Clavulanate Potassium, Amoxicillin and Clavulanate
Swedish Amoxicillin-kalium-klavulansyrakombination
Czech amoxicilin-kyselina klavulanová, kombinace amoxicilin-klavulanát draselný
Finnish Amoksisilliini-kaliumklavulanaatti-yhdistelmä
Russian AMOKSITSILLINA-KALIIA KLAVULANATA KOMBINATSIIA, AMOKSITSILLIN-KLAVULANOVAIA KISLOTA, АМОКСИЦИЛЛИН-КЛАВУЛАНОВАЯ КИСЛОТА, АМОКСИЦИЛЛИНА-КАЛИЯ КЛАВУЛАНАТА КОМБИНАЦИЯ
Japanese クラブラン酸-アモキシシリン, クラブラン酸カリウム-アモキシシリン混合剤, アモキシシリン-クラブラン酸カリウム混合剤, アモキシシリン-クラブラン酸
Italian Amoxi-clavulanato, Amoxicillina-acido clavulanico, Amox-clav, Co-amoxiclav, Amoxicillina potenziata con clavulanato, Combinazione di clavulanato di potassio e amoxicillina
Polish Amoksycylina z solą potasową kwasu klawulanowego, Połączenie amoksycyliny z solą kwasu klawulanowego
Spanish amoxicilina con clavulanato de potasio (sustancia), amoxicilina con clavulanato de potasio (producto), amoxicilina con clavulanato de potasio, amoxicilina con ácido clavulánico (producto), amoxicilina con ácido clavulánico (sustancia), amoxicilina con ácido clavulánico, Amoxicilina-Ácido Clavulánico, Combinación Amoxicilina-Clavulanato de Potasio, Combinación Clavulanato de Potasio-Amoxicilina
French Amoxi-clavulanate, Amoxicilline-acide clavulanique, Amox-clav, Amoxiclavulanate, Amoxycilline-acide clavulanique, Association amoxicilline-clavulanate de potassium, Co-amoxiclav, Coamoxiclav
German Amoxicillin-Kaliumclavulanat-Kombination, Kaliumclavulanat-Amoxicillin-Kombination
Portuguese Amoxicilina-Ácido Clavulânico, Combinação Amoxicilina-Clavulanato de Potássio, Combinação Clavulanato de Potássio-Amoxicilina

Ontology: Augmentin (C0591132)

Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH D019980
French Augmentin
German Augmentin
English augmentin, Augmentin