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# Amoxicillin-Clavulanate (Augmentin)
## Overview
Amoxicillin-clavulanate is a combination penicillin-class antibiotic consisting of amoxicillin (a beta-lactam) and clavulanate potassium (a beta-lactamase inhibitor). The addition of clavulanate extends the spectrum of activity to include beta-lactamase-producing organisms.
## Primary Indications
* Acute bacterial rhinosinusitis
* Community-acquired pneumonia
* Acute otitis media (AOM)
* Skin and soft tissue infections (SSTI)
* Bite wounds (human, dog, or cat)
* Urinary tract infections (complicated or in pregnancy)
## Adult Dosing
Standard dosing is typically provided as the amoxicillin component.
* **Mild to moderate infection:** 500 mg (amoxicillin) every 8 hours OR 875 mg (amoxicillin) every 12 hours.
* **Severe infection/Respiratory tract infection:** 875 mg every 12 hours.
* **Augmentin XR (Extended Release):** 2000 mg every 12 hours (used for resistant *S. pneumoniae*).
## Pediatric Dosing
Dosing is based on the amoxicillin component and dictated by the weight of the child.
* **Standard dose:** 20–45 mg/kg/day divided every 8–12 hours.
* **Recurrent/Resistant AOM:** 80–90 mg/kg/day divided every 12 hours.
* *Note:* Use formulations with a 7:1 or 14:1 ratio of amoxicillin to clavulanate (e.g., 600 mg/5 mL) to minimize diarrhea caused by excess clavulanate.
## Dose Adjustments
* **Renal Impairment (CrCl < 30 mL/min):** Avoid extended-release formulations. Reduce frequency or dose based on specific degree of impairment as per manufacturer labeling.
* **Hepatic Impairment:** Use with caution; monitor liver function.
## Contraindications
* History of serious hypersensitivity (anaphylaxis) to any penicillin or cephalosporins.
* History of cholestatic jaundice or hepatic dysfunction associated with previous use of amoxicillin/clavulanate.
## Adverse Effects
* **Gastrointestinal:** Diarrhea (most common, dose-dependent), nausea, vomiting.
* **Dermatologic:** Rash (specifically maculopapular rash).
* **Hepatic:** Transient elevation of LFTs; rare occurrences of cholestatic jaundice (often associated with duration of therapy >14 days or advanced age).
## Key Drug Interactions
* **Warfarin:** May increase INR and risk of bleeding; monitor closely.
* **Methotrexate:** May decrease renal clearance leading to potential toxicity.
* **Probenecid:** Increases and prolongs blood levels of amoxicillin.
* **Oral Contraceptives:** Potential decrease in efficacy (use backup contraception).
## Monitoring
* Monitor for signs of hypersensitivity (anaphylaxis, rash, pruritus).
* Assess for resolution of infection symptoms.
* In prolonged therapy (>2 weeks), periodic monitoring of hepatic and renal function is advised.
* Monitor for *C. difficile*-associated diarrhea if severe diarrhea develops during or after therapy.
## Clinical Pearls
* **Formulation Warning:** Do not use 250 mg or 500 mg tablets interchangeably with 875 mg tablets due to the amount of clavulanate, which can cause severe diarrhea.
* **Administration:** Take with food to minimize GI side effects.
* **AOM Specifics:** High-dose (90 mg/kg/day) is reserved for patients who have received antibiotics within the last 30 days, have concurrent conjunctivitis, or have failed initial therapy.
* **Microbiology:** Does not cover MRSA, *Pseudomonas aeruginosa*, or *Legionella* species.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines and dosing protocols may vary by institution and patient-specific factors. Always verify current prescribing information, package inserts, and local antibiograms before prescribing or administering medication.*
