Amoxicillin/Clavulanate

General

• Type: Amino-Penicillin with a bacterial beta-lactamase inhibitor
• Dosage Forms: oral suspension, tablet, extended release tablet, chewable tablet
• Dosage Strengths: oral suspension: (125/31.25mg)/5mL, (200mg/28.5mg)/5mL, (250mg/62.5mg)/5mL, (400mg/57mg)/5mL, (600mg/42.9mg)/5mL; tablet: 250mg/125mg, 500mg/125mg, 875mg/125mg; extended release tablet: 1000mg/62.5mg; chewable tablet: 200mg/28.5mg, 400mg/57mg
• Routes of Administration: PO
• Common Trade Names: Augmentin, Augmentin XR, Augmentin ES-600

Adult Dosing

Indications by Disease

Disease	Dose	Context
Acute necrotizing ulcerative gingivitis	875 mg PO two times daily	Uncomplicated
Dental abscess	875 mg PO q12 hours x 7-14 days	Outpatient
Diabetic foot infection	875/125mg PO q12hrs	Moderate DFI
Diverticulitis	875/125mg PO Q8hrs x 5 days	Uncomplicated, Preferred
Endocarditis	12g/day in 4 doses	Native Valve Endocarditis
Erysipelas	500mg PO BID x 10 days	Treatment Failure
Impetigo	875mg (12.5mg/kg) PO q12hrs x 10 days	Oral therapy
Mammalian bites	875mg PO BID x 5-7 days	Human bites
Mammalian bites	875mg PO BID x 5-7 days	Cat and dog bites
Mastitis	875mg PO q12hrs	Alternative
Neutropenic fever	875mg PO q12hrs x 7 days	Outpatient with Ciprofloxacin
Peritonsillar abscess	875 mg PO BID x 7-10d	Outpatient
Pneumonia (main)	500 mg/125 mg TID OR amox/clav 875 mg/125 mg BID OR 2,000 mg/125 mg BID	Outpatient, Unhealthy
Suppurative parotitis	875mg (45mg/kg) PO BID	Outpatient

Pediatric Dosing

Infection, Bacterial

• 25-45mg/kg PO divided q12h

Indications by Disease

Disease	Dose	Context
Acute otitis media	80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days	Treatment Failure
Dental abscess	25-45mg/kg/day PO divided BID x 7-10 days (max 875mg/dose)	Pediatric Outpatient
Impetigo	25mg/kg/day PO divided BID x 7-10 days	Pediatric Oral
Mammalian bites	25-45mg/kg/day PO divided BID x 5-7 days	Pediatric cat and dog bites
Mammalian bites	25-45mg/kg/day PO divided BID x 5-7 days	Pediatric Human bites
Peritonsillar abscess	45mg/kg/day PO divided BID (max 875mg/dose)	Pediatric Outpatient
Suppurative parotitis	45mg/kg/day PO divided BID (max 875mg/dose)	Pediatric Outpatient

Special Populations

• Pregnancy risk: B
• Lactation: probably safe
• Renal Dosing
  • Adult: CrCl 10-30: give q12h, CrCl < 10, give q24h
  • Pediatric: CrCl 10-30: give q12h, CrCl < 10, give q24h
• Hepatic Dosing
  • Adult: none
  • Pediatric: none

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Anaphylaxis
• Steven Johnson syndrome
• C. diff associated diarrhea
• Hemolytic anemia
• Leukopenia
• Thrombocytopenia
• Hepatitis
• Seizures

Common

• Diarrhea
• Nausea and vomiting
• Rash
• Pruritus
• Glossitis
• Transaminitis

Pharmacology

• Half-life: 1.1 hour
• Metabolism: Liver
• Excretion: urine
• Mechanism of Action:Bactericidal, inhibits cell wall mucopeptide synthesis, inhibits beta lactamases

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	S
	Enterococcus faecalis	S
	Enterococcus faecium	S
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	C. jeikeium	R
	L. monocytogenes	X2
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	I
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	I
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	S
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	S
	Bacteroides fragilis	S
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)