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# Amoxicillin-Clavulanate (AmoxCV)
## Overview
Amoxicillin-clavulanate is a combination antibiotic consisting of amoxicillin, a penicillin-class beta-lactam antibiotic, and clavulanate potassium, a beta-lactamase inhibitor. This combination expands the spectrum of amoxicillin to include bacteria that produce beta-lactamase enzymes.
## Primary Indications
* Bacterial sinusitis
* Acute otitis media
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and skin structure infections
* Urinary tract infections
## Adult Dosing
Dosing is typically based on the amoxicillin component.
* **Common Infections:** 500 mg amoxicillin/125 mg clavulanate orally every 12 hours for 7-10 days, or 875 mg amoxicillin/125 mg clavulanate orally every 24 hours for 7-10 days.
* **Severe Infections:** 875 mg amoxicillin/125 mg clavulanate orally every 12 hours for 7-10 days.
* **Maximum Dose:** 875 mg amoxicillin every 12 hours.
## Pediatric Dosing
Dosing is based on amoxicillin weight-based recommendations and formulation. Clavulanate component impacts total daily dose.
* **Less Severe Infections:** 25 mg/kg/day to 45 mg/kg/day divided into two doses, not to exceed 875 mg amoxicillin per dose.
* **More Severe Infections:** Up to 60 mg/kg/day divided into two doses, not to exceed 875 mg amoxicillin per dose.
* **Age/Weight Considerations:** Formulations vary (e.g., 125/31.25 mg per 5 mL, 200/28.5 mg per 5 mL, 400/57 mg per 5 mL). Prescribe based on total amoxicillin required.
## Dose Adjustments
* **Renal Impairment (Adults):**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 10-30 mL/min: 500 mg amoxicillin/125 mg clavulanate every 12 hours or 875 mg amoxicillin/125 mg clavulanate every 24 hours.
* CrCl < 10 mL/min: 500 mg amoxicillin/125 mg clavulanate every 24 hours.
* **Renal Impairment (Pediatrics):** Dose reduction is necessary based on renal function and total amoxicillin dose. Consult specific pediatric renal dosing guidelines.
## Contraindications
* Known serious hypersensitivity to amoxicillin, clavulanate, penicillin, or cephalosporins.
* History of cholestatic jaundice or hepatic dysfunction associated with amoxicillin-clavulanate.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache.
* **Serious:** Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, hepatotoxicity (especially with prolonged use or high doses), seizures (rare, with high IV doses or renal impairment).
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum levels of amoxicillin.
* **Oral Contraceptives:** May decrease efficacy.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Allopurinol:** Increased incidence of rash.
## Monitoring
* **Renal Function:** Essential for dose adjustments, especially in elderly patients or those with known renal impairment.
* **Liver Function:** Consider baseline and periodic monitoring with prolonged therapy or in patients with risk factors for liver disease.
* **Signs of Hypersensitivity:** Assess for rash, pruritus, and breathing difficulties.
* **Diarrhea:** Monitor for signs and symptoms of C. difficile infection.
## Clinical Pearls
* Administer with or without food, but taking with food may minimize gastrointestinal upset.
* Shake oral suspension well before each use.
* Complete the full course of therapy as prescribed, even if symptoms improve.
* Clavulanate is susceptible to degradation; store suspensions properly.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive patient care decisions. Dosages and recommendations may vary based on patient-specific factors and local protocols.
