Guest

Drug Name: Augmentin (Amoxicillin-Clavulanate acid)

Click on the titles below for drug details

  • Clavulanic acid binds and inhibits beta-lactamases that usually inactivate amoxicillin. Allows for amoxicillin to have expanded coverage- inhibits cell wall synthesis by binding PBPs, which inhibits the final transpeptidation step for cell wall synthesis. Causes bacteria to ultimately lyse as the bacteria's autolytic enzymes break down the cell wall during active assembly
  • Based on amoxicillin component (Not all products are interchangeable)
    • Augmentin and Augmentin-ES are two different dosage formulations with different ratios of Amoxicillin to Clavulanic Acid.
    • Augmentin table
    • Additional Dosage Form considerations:
      • Chewable tablet formulation (Amoxicillin:Clavulanate): 200mg-28.5mg and 400mg-57mg
      • Extended Release 12-hour Tablet (Amoxicillin:Clavulanate): 1000mg-62.5mg
    • Standard Augmentin (7:1 Ratio - 400 mg Amoxicillin: 57 mg Clavulanic Acid per 5mL)
      • This dosage should NOT be used for "High-Dose" regimens (45 mg/kg BID) as you would overdose the clavulanic acid (and may cause more significant diarrhea)
    • Augmentin-ES (14:1 Ratio - 600 mg Amoxicillin: 42.9 mg Clavulanic Acid per 5 mL)
      • This should ONLY be used for "High-Dose" regimens (45 mg/kg BID)
      • If used in standard dosing, the lower amount of Clavulanic Acid may result in reduced efficacy against Beta-lactamase-producing organisms.
  • AOM, CAP, sinusitis: 45 mg/kg/dose BID (max 1750 mg if using 600 mg/5mL suspension, 2000 mg if using 1000 mg/62.5 mg tablets)
  • Bites, dental infection, RPA: 22.5 mg/kg/dose BID (max 875 mg if 400mg/57 mg)
  • Patients with abnormal renal function (<30 mL/minute/1.73 m2) require renal dosing adjustment, generally extending the dosing interval. Talk to your friendly pharmacist.
  • Dental infections
  • Retropharyngeal and peritonsillar infections
  • Pre-septal and orbital cellulitis (not MRSA)
  • Skin and soft tissues infections (not MRSA)
  • Bites (humans, dogs, cats)
  • Urinary tract infections
  • Recurrent acute otitis media or concern for H. influenzae infection (otitis-conjunctivitis syndrome)
  • Failed otitis media or pneumonia treatment with amoxicillin OR in unvaccinated patients
  • Does NOT cover MRSA or Pseudomonas aeruginosa
  • Hypersensitivity to amoxicillin or other beta-lactam drugs
  • History of cholestatic jaundice or hepatic dysfunction
  • XR formulation: Severe renal impairment, patients on hemodialysis
  • GI reactions: Diarrhea, nausea, vomiting (more common with higher clavulanate doses/more frequent dosing; C. diff infection
    • Rare cholestatic hepatitis
  • Hypersensitivity:
    • Immediate: urticaria, angioedema, anaphylaxis
    • Delayed: rash, SJS, TEN, DRESS
  • Amoxicillin is readily distributed throughout the body, poor penetration into cerebrospinal fluid with uninflamed meninges.
  • Can cause diarrhea in the duration of treatment that typically will improve after therapy; clavulanic acid can cause increase small bowel motility in addition to disrupting the natural gut microbiome
  • May cause a rash (similar to amoxicillin). Rashes that occur later in treatment as opposed to immediate onset are likely not a penicillin allergy, but always monitor for other signs of allergy to the medication such as vomiting, difficulty breathing, swelling of the lips/tongue, worsening rash.