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# Amoxicillin-Clavulanate (Augmentin)
## Overview
Amoxicillin-clavulanate is a combination broad-spectrum penicillin-class antibiotic. Amoxicillin provides bactericidal activity against susceptible bacteria, while clavulanate potassium acts as a beta-lactamase inhibitor, preventing the degradation of amoxicillin by beta-lactamase-producing organisms.
## Primary Indications
* Acute bacterial rhinosinusitis
* Community-acquired pneumonia
* Otitis media
* Skin and skin structure infections
* Urinary tract infections
* Animal/human bite prophylaxis and treatment
## Adult Dosing
Standard dosing is based on the amoxicillin component:
* **Mild to moderate infections:** 500 mg amoxicillin/125 mg clavulanate every 8 hours or 875 mg amoxicillin/125 mg clavulanate every 12 hours.
* **Severe infections / Respiratory tract:** 875 mg amoxicillin/125 mg clavulanate every 12 hours.
* **Note:** Products with a 1:1 ratio (e.g., 2000 mg/125 mg extended-release) are sometimes used for resistant *S. pneumoniae* (refer to local guidelines).
## Pediatric Dosing
Dosing is based on weight (amoxicillin component):
* **General infection:** 20–45 mg/kg/day divided every 8–12 hours.
* **Otitis media/Severe infection:** 80–90 mg/kg/day divided every 12 hours.
* **Maximum:** Do not exceed 875 mg amoxicillin per dose.
* *Note:* Use the specific formulation ratio (e.g., 400 mg/5 mL vs 200 mg/5 mL) to ensure the clavulanate component does not exceed daily limits (typically ≤ 10 mg/kg/day of clavulanate).
## Dose Adjustments
* **Renal Impairment:** Adjust dose for CrCl < 30 mL/min. Avoid extended-release formulations in severe renal impairment.
* **Hepatic Impairment:** Use with caution; monitor hepatic function.
## Contraindications
* History of serious hypersensitivity reactions (anaphylaxis) to any penicillin.
* History of cholestatic jaundice or hepatic dysfunction associated with previous use of amoxicillin-clavulanate.
## Adverse Effects
* **Common:** Diarrhea (frequent), nausea, vomiting, rash, abdominal discomfort.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hepatotoxicity (usually cholestatic jaundice), hypersensitivity reactions (Stevens-Johnson syndrome, anaphylaxis).
## Key Drug Interactions
* **Methotrexate:** May decrease renal clearance of methotrexate, increasing toxicity risk.
* **Warfarin:** May increase the INR; monitor closely during and after therapy.
* **Mycophenolate:** May reduce systemic exposure of mycophenolic acid.
* **Oral Contraceptives:** May decrease efficacy (though evidence is inconsistent; provide counseling on backup contraception).
## Monitoring
* Assess for allergic reactions or anaphylaxis during the first dose.
* Monitor LFTs if therapy duration is prolonged.
* Monitor for signs of *C. difficile* (persistent watery diarrhea).
## Clinical Pearls
* **Administration:** Take with food or at the start of a meal to reduce GI side effects and improve absorption.
* **Formulation Warning:** 250 mg tablets and 500 mg tablets contain the same amount of clavulanate (125 mg). Do not substitute two 250 mg tablets for one 500 mg tablet to avoid excessive clavulanate, which increases diarrhea risk.
* **Resistance:** Clavulanate expansion of the spectrum does not cover MRSA or *Pseudomonas*.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional guidelines, and patient-specific factors (e.g., allergies, renal function) via clinical databases like Lexicomp or UpToDate before prescribing.*
