Combination of two antibacterials. The addition of clavulanic acid to amoxicillin extends its spectrum of activity to cover beta-lactamase producing Gram-positive and Gram-negative organisms, including some Gram-negative anaerobes.
Indications
Animal bites, if antibiotic therapy or antibiotic prophylaxis is clearly indicated
Second line treatment of acute otitis media and acute bacterial sinusitis, when amoxicillin alone given at high dose failed
Acute uncomplicated cystitis(no systemic signs) in girls over 2 years
Postpartum upper genital tract infection
Parenteral to oral switch therapy in severe infections (e.g. severe pneumonia)
Forms and strengths
The ratio of amoxicillin and clavulanic acid varies according to the manufacturer:
Ratio 8:1
500 mg amoxicillin/62.5 mg clavulanic acid tablet
500 mg amoxicillin/62.5 mg clavulanic acid/5ml powder for oral suspension
Animal bites; second line treatment of acute otitis media and acute sinusitis
Child < 40 kg: 25 mg/kg 2 times daily
Child ≥ 40 kg and adult:
Ratio 8:1: 2000 mg daily = 2 tablets of 500/62.5 mg 2 times daily
Ratio7:1: 1750 mg daily = 1 tablet of 875/125mg 2 times daily
Acute uncomplicated cystitis in girls > 2 years
12.5 mg/kg 2 times daily
Postpartum upper genital tract infection; parenteral to oral switch therapy in severe infections
Child < 40 kg: 50 mg/kg 2 times daily
Child ≥ 40 kg and adult:
Ratio 8:1: 3000 mg daily = 2 tablets of 500/62.5 mg 3 times daily
Ratio7:1: 2625 mg daily = 1 tablet of 875/125mg 3 times daily
Duration
Animal bites: 5 to 7 days
Otitis media: 5 days
Sinusitis: 7 to 10 days
Cystitis: 3days
Upper genital tract infection: 7 days
Parenteral to oral switch therapy in severe pneumonia: to complete a total of 10 to 14 days of treatment.
Contra-indications, adverse effects, precautions
Do not administer to penicillin-allergic patients and patients with history of hepatic disorders during a previous treatment with co-amoxiclav.
Administer with caution to patients allergic to cephalosporins (cross-sensitivity may occur).
Administer with caution to patients with hepatic impairment; reduce dosage and give every 12 to 24 hours in patients with severe renal impairment.
May cause: gastrointestinal disturbances (mainly diarrhoea); allergic reactions sometimes severe (stop treatment immediately); jaundice and cholestatic hepatitis in the event of prolonged treatment (> 10 to 15 days).
The dose of clavulanic acid should not exceed 12.5 mg/kg daily or 375 mg daily.
Pregnancy: no contra-indication
Breast-feeding: no contra-indication
Remarks
Take with meals.
Also comes in formulations with a ratio of amoxicillin/clavulanic acid of4:1: 125 mg amoxicillin/31.25 mg clavulanic acid/5 ml powder for oral suspension and 500 mg amoxicillin/125 mg clavulanic acid tablet. The maximum dose (expressed in amoxicillin) that can be given with these formulations is 50 mg/kg daily, without exceeding 1500 mg daily.