Megacv%252525252525252525252525252525252525252525252525252520duo

# Amoxicillin-Clavulanate Potassium (Megacv%2525252525252525252525252525252525252525252525252520duo) ## Overview Amoxicillin-clavulanate potassium is a combination antibiotic consisting of amoxicillin, a penicillin-class beta-lactam antibiotic, and clavulanate potassium, a beta-lactamase inhibitor. Clavulanate potassium protects amoxicillin from degradation by many bacterial beta-lactamases, thereby extending its spectrum of activity. Available in oral (tablets, chewable tablets, oral suspension) and intravenous formulations. ## Primary Indications * Bacterial sinusitis * Acute otitis media * Bacterial exacerbations of chronic bronchitis * Community-acquired pneumonia * Urinary tract infections (complicated and uncomplicated) * Skin and skin structure infections (including animal bites and cellulitis due to $\textit{Capnocytophaga canimorsus}$) * Bone and joint infections * Periodontal infections ## Adult Dosing Dosing is based on the amoxicillin component. * **Oral Tablets/Chewable Tablets:** * **250 mg amoxicillin/125 mg clavulanate:** 1 tablet every 8 hours. * **500 mg amoxicillin/125 mg clavulanate:** 1 tablet every 8 or 12 hours. * **875 mg amoxicillin/125 mg clavulanate:** 1 tablet every 12 hours. * Maximum daily dose of amoxicillin is typically 4000 mg, particularly when using the 875 mg tablet every 12 hours. However, some guidelines suggest a maximum amoxicillin dose of 1750 mg/day for patients using the 875 mg formulation for less severe infections to minimize GI side effects. * **Oral Suspension:** * **200 mg amoxicillin/28.5 mg clavulanate per 5 mL:** Usual dose is 5 mL every 8 hours. * **400 mg amoxicillin/57 mg clavulanate per 5 mL:** Usual dose is 5 mL every 12 hours or 10 mL every 12 hours depending on severity. * Maximum daily dose of amoxicillin is typically 4000 mg. * **Intravenous:** * **600 mg amoxicillin/125 mg clavulanate:** 1 vial every 8 hours. * **1200 mg amoxicillin/200 mg clavulanate:** 1 vial every 12 hours. * **1200 mg amoxicillin/200 mg clavulanate:** 1 vial every 8 hours for severe infections. * Dosage varies significantly based on type and severity of infection and renal function. ## Pediatric Dosing Dosing is based on the amoxicillin component and patient weight. Clavulanate dose is adjusted proportionally. * **Oral Suspension:** * **200 mg amoxicillin/28.5 mg clavulanate per 5 mL:** * For otitis media, sinusitis, and lower respiratory tract infections: 90 mg/kg/day amoxicillin divided into two doses every 12 hours. * For other infections: 45 mg/kg/day amoxicillin divided into three doses every 8 hours. * **400 mg amoxicillin/57 mg clavulanate per 5 mL:** * For otitis media, sinusitis, and lower respiratory tract infections: 45 mg/kg/day amoxicillin divided into two doses every 12 hours. (This is the higher dose regimen). * Maximum daily amoxicillin dose in pediatrics is 90 mg/kg/day (up to 4000 mg/day). * **Intravenous:** * **30 mg/kg/dose amoxicillin every 8 hours** for mild to moderate infections, not to exceed 1200 mg/dose. * **60 mg/kg/dose amoxicillin every 8 hours** for severe infections, including those with significant beta-lactamase producing organisms, not to exceed 3000 mg/dose. ## Dose Adjustments * **Renal Impairment:** * **Oral:** * CrCl > 30 mL/min: No dose adjustment. * CrCl 10-30 mL/min: Oral doses should be reduced by half, given at the same frequency (every 8 or 12 hours depending on regimen). For regimens requiring every 8-hour dosing, consider extending interval to every 12 hours. For every 12-hour regimens, consider extending to every 24 hours. * CrCl < 10 mL/min: Oral doses should be reduced by two-thirds, given at the same frequency. For regimens requiring every 8-hour dosing, consider extending interval to every 24 hours. For every 12-hour regimens, consider extending to every 48 hours. * **Intravenous:** * CrCl > 30 mL/min: Usual dose every 8 hours. * CrCl 10-30 mL/min: Usual dose every 12 hours. * CrCl < 10 mL/min: Usual dose every 24 hours. * Hemodialysis: 1200 mg (1000 mg amoxicillin/200 mg clavulanate) every 24 hours, and administer a 600 mg dose (500 mg amoxicillin/100 mg clavulanate) after dialysis. ## Contraindications * Known serious hypersensitivity to penicillin, amoxicillin, clavulanate potassium, or any component of the formulation. * History of jaundice or hepatic dysfunction associated with amoxicillin-clavulanate potassium. ## Adverse Effects * **Gastrointestinal:** Diarrhea, nausea, vomiting, abdominal pain, dyspe