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# Amoxicillin-Clavulanate (Augmentin)
## Overview
A combination antibiotic consisting of amoxicillin (a beta-lactam) and clavulanate potassium (a beta-lactamase inhibitor). The inhibitor expands the spectrum of activity to include beta-lactamase-producing organisms.
## Primary Indications
Acute bacterial rhinosinusitis, community-acquired pneumonia, otitis media, bite wounds, and skin/soft tissue infections caused by susceptible beta-lactamase-producing bacteria (e.g., *H. influenzae*, *M. catarrhalis*, *S. aureus*).
## Adult Dosing
* **Standard dose:** 500 mg amoxicillin/125 mg clavulanate every 8 to 12 hours.
* **High dose (respiratory infections):** 875 mg amoxicillin/125 mg clavulanate every 12 hours.
* **Extended release (XR):** 2000 mg amoxicillin/125 mg clavulanate every 12 hours.
## Pediatric Dosing
Dosing must be based on the amoxicillin component. Use the lowest clavulanate ratio feasible to reduce diarrhea risk.
* **Standard dose:** 25 mg/kg/day (based on amoxicillin component) divided every 12 hours.
* **Otitis Media:** 80–90 mg/kg/day divided every 12 hours (use 600 mg/5 mL or 400 mg/5 mL suspensions).
* **Note:** Do not use 250 mg tablets for pediatric patients; use appropriate oral suspension strengths.
## Dose Adjustments
* **Renal Impairment:** If CrCl < 30 mL/min, the 875 mg formulation is contraindicated. Adjust frequency (e.g., every 12h or 24h) for lower CrCl.
* **Hepatic Impairment:** Use with caution; monitor liver function.
## Contraindications
* History of cholestatic jaundice or hepatic dysfunction associated with previous amoxicillin/clavulanate therapy.
* Severe hypersensitivity (including anaphylaxis) to penicillins or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea (frequently associated with the clavulanate component), nausea, vomiting, skin rash.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hepatitis/cholestatic jaundice, severe hypersensitivity reactions (anaphylaxis) or Stevens-Johnson Syndrome.
## Key Drug Interactions
* **Methotrexate:** Amoxicillin may decrease renal clearance, increasing methotrexate toxicity.
* **Warfarin:** May increase INR/bleeding risk; monitor PT/INR during treatment.
* **Probenecid:** Decreases renal excretion of amoxicillin, potentially leading to increased systemic concentrations.
## Monitoring
* Monitor periodic liver function tests (LFTs) if used for >2 weeks.
* Observe for signs of severe diarrhea (CDAD) or signs of systemic hypersensitivity.
* Monitor renal function in patients with pre-existing impairment.
## Clinical Pearls
* **Diarrhea Management:** Administer with or immediately after a meal to reduce GI upset and tolerance issues.
* **Clavulanate Ratio:** Use the appropriate formulation ratio (e.g., 4:1, 7:1) to prevent "clavulanate overdose," which often causes severe diarrhea.
* **Suspension:** Must be refrigerated and discarded after 10 days.
* **Allergy:** Cross-reactivity with cephalosporins is low but possible; use with extreme caution in patients with a history of penicillin anaphylaxis.
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**Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, dosing guidelines, and patient-specific contraindications against institutional protocols and primary clinical references (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
