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# Amoxicillin-Clavulanate Potassium ## Overview Amoxicillin-clavulanate potassium is a combination penicillin-type antibiotic and beta-lactamase inhibitor. Clavulanate potassium expands the spectrum of amoxicillin by inhibiting beta-lactamase enzymes, which are produced by some bacteria to inactivate penicillins. ## Primary Indications * Bacterial sinusitis * Acute otitis media * Lower respiratory tract infections (e.g., community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis) * Urinary tract infections (complicated and uncomplicated) * Skin and skin structure infections (e.g., cellulitis, animal bites, perianal abscesses) ## Adult Dosing * **Dosing is typically based on the amoxicillin component.** * **Sinusitis, Otitis Media, Lower Respiratory Tract Infections, Skin/Skin Structure Infections:** * **Mild to moderate:** 500 mg amoxicillin/125 mg clavulanate orally every 12 hours, or 250 mg amoxicillin/125 mg clavulanate orally every 8 hours. * **Severe:** 875 mg amoxicillin/125 mg clavulanate orally every 12 hours. * **Urinary Tract Infections:** * **Complicated:** 875 mg amoxicillin/125 mg clavulanate orally every 12 hours. * **Uncomplicated:** 500 mg amoxicillin/125 mg clavulanate orally every 12 hours, or 250 mg amoxicillin/125 mg clavulanate orally every 8 hours. * **Duration of therapy:** Varies by indication, typically 7-10 days. ## Pediatric Dosing * **Dosing is based on amoxicillin component and weight.** * **For children weighing 40 kg (88 lbs) or less:** * **Mild to moderate infections:** * 25 mg amoxicillin/kg/day to 45 mg amoxicillin/kg/day divided into two doses (every 12 hours). * 40 mg amoxicillin/kg/day to 60 mg amoxicillin/kg/day divided into three doses (every 8 hours). * **Severe infections:** * Up to 60 mg amoxicillin/kg/day divided into two doses (every 12 hours) or three doses (every 8 hours). * **For children weighing greater than 40 kg (88 lbs):** Use adult doses. * **Maximum dose:** Generally not to exceed the maximum adult dose. Specific mg/kg calculations are often guided by local protocols. ## Dose Adjustments * **Renal Impairment:** Dose adjustments are necessary based on the calculated creatinine clearance (CrCl). Refer to specific guidelines or product labeling for precise adjustments. * CrCl > 30 mL/min: No adjustment typically needed. * CrCl 10-30 mL/min: Reduce dose frequency. (e.g., every 18-24 hours for q12h regimens, or every 12 hours for q8h regimens). * CrCl < 10 mL/min: Reduce dose frequency to once daily. * **Hepatic Impairment:** Use with caution. Monitor liver function. ## Contraindications * Known serious hypersensitivity to amoxicillin, clavulanate, or penicillins. * History of cholestatic jaundice or hepatic dysfunction associated with amoxicillin-clavulanate. ## Adverse Effects * **Most Common:** Diarrhea, nausea. * **Gastrointestinal:** Vomiting, abdominal pain, dyspepsia. * **Skin:** Rash, pruritus, urticaria. * **Hepatic:** Hepatitis, cholestatic jaundice (more common with higher doses and longer duration of therapy, particularly in older adults). * **Hematologic:** Anemia, thrombocytopenia, leukopenia, eosinophilia. * **Allergic Reactions:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis. * **Other:** Headache, dizziness. ## Key Drug Interactions * **Probenecid:** May increase amoxicillin-clavulanate serum levels. * **Oral Contraceptives:** May decrease efficacy. Advise alternative contraception. * **Warfarin:** May increase INR. Monitor INR closely. * **Allopurinol:** Increased incidence of rash. * **Bacteriostatic antibiotics (e.g., erythromycin, tetracyclines):** May antagonize the effect of amoxicillin-clavulanate. ## Monitoring * **Renal function:** Especially in patients with underlying renal disease or those receiving concomitant nephrotoxic agents. * **Liver function:** Especially with prolonged therapy or in patients with pre-existing liver disease. * **Signs of C. difficile-associated diarrhea (CDAD):** Monitor for persistent or severe diarrhea. * **Signs of hypersensitivity reactions:** Counsel patients on symptoms to watch for. * **Therapeutic response:** Assess for improvement in signs and symptoms of infection. ## Clinical Pearls * Take with or without food, but taking with food may reduce gastrointestinal upset. * The clavulanate component is susceptible to degradation; store suspensions appropriately and discard after recommended reconstitution time. * Ensure adequate hydration, especially when treating urinary tract infections. * Be aware of the potential for superinfections with resistant organisms. * In penicillin-allergic patients, consider cross-reactivity, although the rate is lower than with penicillin alone. *** *Disclaimer: This information is for educational purposes and does not substitute for professional medical advice. Always consult the most current Prescribing Information and product labeling, or a qualified healthcare provider, for complete and up-to-date drug information before making any treatment decisions.*