Please check your internet connection and try again.
# Amoxicillin-Clavulanate (Augmentin)
## Overview
Amoxicillin-clavulanate is a combination of a penicillin-class antibiotic (amoxicillin) and a beta-lactamase inhibitor (clavulanate potassium). The addition of clavulanate expands the spectrum of activity to include beta-lactamase-producing organisms (e.g., *H. influenzae*, *M. catarrhalis*, *S. aureus*).
## Primary Indications
* Acute bacterial rhinosinusitis
* Community-acquired pneumonia
* Otitis media
* Skin/soft tissue infections (animal/human bites)
* Urinary tract infections
## Adult Dosing
Standard dosing is based on the amoxicillin component:
* **Mild to Moderate Infections:** 500 mg amoxicillin every 8 or 12 hours.
* **Severe Infections/Respiratory Tract:** 875 mg amoxicillin every 12 hours.
* **Extended Release (XR):** 2000 mg every 12 hours (for specific indications like CAP).
## Pediatric Dosing
Dosing is based on the amoxicillin component and the specific formulation concentration. Pediatric patients ≥ 40 kg should receive adult dosing.
* **General/Otitis Media:** 80–90 mg/kg/day divided every 12 hours (using the 600 mg/5 mL formulation to minimize clavulanate exposure).
* **Mild Infections:** 20–45 mg/kg/day divided every 8–12 hours.
## Dose Adjustments
* **Renal Impairment:** If CrCl < 30 mL/min, the XR formulation and the 875 mg tablet are contraindicated. Adjust dosing intervals for lower GFR based on specific guidelines (e.g., transition to 500 mg or 250 mg tablets depending on severity).
* **Hepatic Impairment:** Use with caution; monitor hepatic function.
## Contraindications
* History of serious hypersensitivity (anaphylaxis) to penicillin or any beta-lactam.
* History of cholestatic jaundice or hepatic dysfunction associated with previous use of amoxicillin-clavulanate.
## Adverse Effects
* **Most Common:** Diarrhea and nausea (often dose-dependent on clavulanate).
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hepatotoxicity (cholestasis/elevated LFTs), hypersensitivity reactions (rash, SJS/TEN).
## Key Drug Interactions
* **Methotrexate:** Amoxicillin may decrease renal excretion of methotrexate, increasing risk of toxicity.
* **Warfarin:** May increase INR (monitor closely during therapy).
* **Oral Contraceptives:** Potential for reduced efficacy (use barrier backup).
* **Probenecid:** Decreases renal excretion of amoxicillin, increasing serum levels.
## Monitoring
* Monitor for signs of hypersensitivity (rash, pruritus).
* Monitor LFTs if therapy duration exceeds 14 days.
* Assess for frequent or watery stool (potential *C. diff*).
## Clinical Pearls
* **Clavulanate Load:** To minimize diarrhea, choose the formulation with the lowest ratio of clavulanate required for the indication.
* **Administration:** Take with food or a meal to improve tolerability and reduce GI side effects.
* **Storage:** Most oral suspensions require refrigeration and expire after 10 days.
***
*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via resources like Lexicomp, Epocrates, or the package insert before prescribing or administering medication.*
