Amoxicillin Clavulanate

Aka: Amoxicillin Clavulanate, Augmentin

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II. 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

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

X. Resources

  1. Amoxicillin Clavulanate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=963e7bea-ff5d-420a-9cb2-e4aefb534b33

XI. 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]

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