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# Amoxicillin-Clavulanate (Augmentin)
## Overview
Amoxicillin-clavulanate is a combination penicillin-type antibiotic and beta-lactamase inhibitor. It is effective against many common bacteria, including beta-lactamase producing strains.
## Primary Indications
* Acute bacterial sinusitis
* Acute otitis media
* Community-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections
## Adult Dosing
* **Mild-to-moderate infections:** 500 mg amoxicillin/125 mg clavulanate orally every 12 hours or 875 mg amoxicillin/125 mg clavulanate orally every 24 hours.
* **Severe infections:** 875 mg amoxicillin/125 mg clavulanate orally every 12 hours.
* **Duration:** Typically 7-10 days, depending on infection severity and type.
## Pediatric Dosing
Dosing is based on amoxicillin component and weight. Clavulanate dose is typically 2.5 mg/kg/dose (max 125 mg) for every 12-hour dosing or 4.4 mg/kg/dose (max 62.5 mg) for every 24-hour dosing.
* **Children weighing <40 kg:**
* **Mild-to-moderate infections:** 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 24 hours.
* **Severe infections (e.g., otitis media, sinusitis, lower respiratory tract infections):** 90 mg/kg/day divided every 12 hours or 80 mg/kg/day divided every 24 hours.
* **Children weighing ≥40 kg:** Use adult doses.
* **Maximum dose:** 4000 mg amoxicillin/day for children treated for more severe infections; 600 mg amoxicillin/day for children treated for mild-to-moderate infections.
## Dose Adjustments
Dose reduction is recommended in severe renal impairment (CrCl < 30 mL/min). Consult prescribing information for specific recommendations based on CrCl.
## Contraindications
* Hypersensitivity to amoxicillin, clavulanate potassium, or penicillins.
* History of cholestatic jaundice or hepatic dysfunction associated with amoxicillin-clavulanate.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, abdominal pain.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe allergic reactions (anaphylaxis), hepatotoxicity, seizures.
## Key Drug Interactions
* **Probenecid:** May increase amoxicillin serum concentrations.
* **Oral contraceptives:** May decrease efficacy.
* **Warfarin:** May increase INR.
* **Mycophenolate mofetil:** May decrease mycophenolic acid concentrations.
## Monitoring
* Signs and symptoms of infection.
* Liver function tests in patients with pre-existing hepatic impairment or those on prolonged therapy.
* For severe diarrhea, rule out *C. difficile*-associated diarrhea.
## Clinical Pearls
* Administer with or without food; taking with food may reduce gastrointestinal upset.
* Shake oral suspensions well before each use and discard after a specified period (e.g., 10 days).
* Ensure adequate hydration.
* Counsel patients on the potential for diarrhea and to report severe or persistent diarrhea.
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**Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions. Dosing may vary based on local protocols and individual patient factors.
