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# Amoxicillin-Clavulanate Potassium
## Overview
Amoxicillin-clavulanate potassium is a combination antibiotic consisting of amoxicillin, a penicillin-class antibiotic, and clavulanate potassium, a beta-lactamase inhibitor. It is active against a broad spectrum of bacteria.
## Primary Indications
* Bacterial sinusitis
* Acute otitis media
* Bacterial pneumonia
* Skin and skin structure infections
* Urinary tract infections
* Bite wound infections
## Adult Dosing
* **Sinusitis, Pneumonia, Skin 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.
* **Urinary Tract Infections:** 875 mg amoxicillin/125 mg clavulanate orally every 12 hours for 7 days.
* **Bite Wound Infections:** 500 mg amoxicillin/125 mg clavulanate orally every 8 hours for 7-10 days.
## Pediatric Dosing
Dosing is based on amoxicillin component and the child's weight. Actual doses should be confirmed with local protocols.
* **Acute Otitis Media, Sinusitis, Pneumonia:** 90 mg/kg/day divided every 12 hours for 10 days (max 4000 mg/day amoxicillin component).
* **Other Indications:** 45 mg/kg/day divided every 12 hours for 10 days (max 4000 mg/day amoxicillin component).
* For children weighing 40 kg or more, use adult doses.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No dose adjustment needed.
* CrCl 10-30 mL/min: 500 mg amoxicillin/125 mg clavulanate orally every 12 hours.
* CrCl < 10 mL/min: 500 mg amoxicillin/125 mg clavulanate orally every 24 hours.
* For 875 mg/125 mg formulation: Administer 500 mg/125 mg every 12 hours if CrCl is 10-30 mL/min. Avoid in CrCl < 10 mL/min.
## Contraindications
* Known serious hypersensitivity to amoxicillin, clavulanate potassium, or penicillins.
* History of cholestatic jaundice or hepatic dysfunction associated with amoxicillin-clavulanate use.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache.
* **Serious:** Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, hepatitis, cholestatic jaundice.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum levels of amoxicillin.
* **Oral Contraceptives:** May decrease efficacy. Advise alternative non-hormonal contraception.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Mycophenolate Mofetil:** Reduced mycophenolic acid concentrations may occur. Monitor for signs of reduced immunosuppression.
## Monitoring
* Assess for signs and symptoms of allergic reaction.
* Monitor for improvement in signs and symptoms of infection.
* Monitor for diarrhea; if severe, consider C. difficile testing.
* Monitor liver function tests in patients with pre-existing hepatic impairment or during prolonged therapy.
## Clinical Pearls
* Administer with or without food; however, taking with food may reduce gastrointestinal upset.
* For pediatric suspensions, reconstitute immediately before first use and refrigerate. Discard after 10 days.
* Ensure adequate hydration to prevent crystalluria.
* A discolored "furry" tongue may occur, which is generally benign.
**Disclaimer:** This information is intended for clinical use and does not replace comprehensive drug information resources. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.
