Names and pronunciation
(a-mox-i-sill′in) Augmentin, Augmentin ES, Augmentin XR, Clavulin
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Drug reference
(a-mox-i-sill′in) Augmentin, Augmentin ES, Augmentin XR, Clavulin
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Func. class.: Broad-spectrum antiinfective
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Chem. class.: Aminopenicillin β-lactamase inhibitor
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ACTION: Bacteriocidal, interferes with cell wall replication of susceptible organisms; lysis mediated by bacterial cell wall autolytic enzymes, combination increases spectrum of activity against β-lactamase–resistant organisms
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USES: Lower respiratory tract infec- tions, sinus infections, pneumonia, otitis media, impetigo, skin infection, UTI; effec- tive for Actinomyces sp., Bacillus anthracis, Bacteroides sp., Bordetella pertussis, Borrelia burgdorferi; Brucella sp., Burkholderia pseudomallei, Clos tridium perfringens/tetani, Corynebac terium diphtheriae, Eikenella cor rodens, Enterobacter sp., Enterococcus faecalis, Erysipelothrix rhusiopathiae, Escherichia coli, Eubacterium sp., Fuso bacterium sp., Haemophilus ducreyi/ parainfluenzae (positive/negative beta- lactamase), Helicobacter pylori, Klebsi ella sp., Lactobacillus sp., Listeria monocytogenes, Moraxella catarrhalis, Neisseria gonorrhoeae/meningitidis, Nocardia brasiliensis, Peptococcus sp., Peptostreptococcus sp., Prevotella melaninogenica, Propionibacterium sp., Shigella sp., Staphylococcus aureus (MSSA)/epidermidis/saprophyticus, Streptococcus agalactiae (group B streptococci)/dysgalactiae/pneu moniae/pyogenes (group A strepto cocci), Treponema pallidum, Vibrio cholerae, Viridans streptococci
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Unlabeled uses: Actinomycotic myce- toma, chancroid, dental infections, den- toalveolar infection, melioidosis, peri- coronitis, SARS
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CONTRAINDICATIONS: Hyper- sensitivity to penicillins, severe renal dis- ease, dialysis Precautions: Pregnancy, breastfeed- ing, neonates, children, hypersensitivity to cephalosporins; renal/GI disease, asthma, colitis, diabetes, eczema, leuke- mia, mononucleosis, viral infections, phenylketonuria
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SIDE EFFECTS CNS: Headache, fever, seizures, agita- tion, insomnia GI: Nausea, diarrhea, vomiting, increased AST/ALT, CDAD GU: Vaginitis HEMA: Anemia, bone marrow depres- sion, granulocytopenia, leukopenia, eosin- ophilia, thrombocytopenic purpura INTEG: Rash, urticaria SYST: Anaphylaxis, respiratory distress, serum sickness
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INTERACTIONS Increase: amoxicillin levels—probenecid, used for this reason Increase: anticoagulant effect—warfarin; monitor closely, dose adjustment may be needed Increase: skin rash—allopurinol Decrease: contraceptive effect—oral contraceptives Drug/Food Decrease: absorption by a high-fat meal Drug/Lab Test Increase: AST/ALT, alkaline phosphatase, LDH Interference: urine glucose tests (Clini test, Benedict’s reagent, cupric SO4)
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DOSAGE AND ROUTES Most infections • Adult/child >40 kg: 250 mg q8hr or 500 mg q12hr Recurrent/persistent otitis media (Streptococcus pneumoniae, Haemo- philus, Moraxella catarrhalis) • Child ≥3 mo: PO 90 mg/kg/day (600 mg amoxicillin/42.9 mg clavula- nate/5 mL) q12hr × 10 days Lower respiratory infections, otitis media, sinusitis, skin/skin structure infections, UTIs • Adult: PO 250-500 mg q8hr or 500- 875 mg q12hr, depending on severity of infection • Child #40 kg: PO 20-90 mg/kg/day in divided doses q8-12hr Community-acquired pneumonia or acute bacterial sinusitis • Adult: PO 2000 mg/125 mg (Augmen- tin XR) q12hr × 7-10 days (pneumonia), 10 days (sinusitis) Renal disease • Adult: PO CCr 10-30 mL/min dose q12hr; CCr <10 mL/min dose q24hr; do not use 875-mg strength or ext rel if CCr <30 mL/min; Augmentin XR is contraindi- cated with renal disease
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Available forms: Tablets 250, 500, 875 A mg amoxicillin/125 mg clavulanate; chew- able tablets 200 mg amoxacillin/28.5 clavu- lanate, 400 mg amoxacillin/57 mg clavula- nate; powder for oral suspension 250 mg amoxacillin/28.5 mg clavulanate, 200 amoxacillin mg/28.5 clavulanate mg, 400 amoxacillin mg/57 clavulanate mg, 600/42.9 mg/5 mL clavulanate extended- release tablets (XR) 1000 mg amoxicil- lin/62.5 mg clavulanate; powder for oral suspension (ES) 600 mg amoxicillin/42.9 mg clavulanate
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Administer: PO route • Do not break, crush, chew extended- release product • Only as directed; two 250-mg tablets not equivalent to one 500-mg tablet due to strength of clavulanate • Shake suspension well before each dose; may be used alone, mixed in drinks; use immediately, discard un- used portion of suspension after 14 days, store in refrigerator • Give around the clock • Give with light meal for increased ab- sorption, fewer GI effects, confusion, be- havioral changes
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Assess: • Infection: For signs/symptoms of infection (characteristics of wounds, sputum, urine, stool, WBC >10,000/ mm3, earache, fever, obtain baseline and during treatment • Superinfection: Perineal itching, fever, malaise, redness, pain, swelling, rash, diarrhea, change in cough sputum; if large doses are given or geriatrics • Hepatic studies: AST, ALT baseline, periodically in hepatic disease, discon- tinue if hepatitis occurs • Blood studies: WBC • C&S may be drawn before product therapy; product may be given as soon as culture is taken • CDAD: bowel pattern before, during treatment; diarrhea, cramping, blood in stools; report to prescriber • Anaphylaxis: rash, itching, dyspnea, facial/laryngeal edema; skin eruptions after administration of penicillin to 1 wk after discontinuing product, adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit
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Evaluate: • Therapeutic response: absence of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take as prescribed, not to double or skip doses • All aspects of product therapy: to com- plete entire course of medication to ensure organism death, that culture may be taken after completed course of medication • That product must be taken in equal intervals around the clock to maintain blood levels • To report sore throat, fever, fatigue (superinfection or agranulocytosis); diar- rhea, cramping, blood in stools (pseudo- membranous colitis) • To wear or carry emergency ID if al- lergic to penicillins • Pregnancy/breastfeeding: To notify health care professional if pregnancy is planned or suspected or if breastfeeding; to use another form of contraception if taking oral contraceptives, effect maybe decreased TREATMENT OF HYPER SENSITIVITY: Withdraw product, maintain airway, administer EPINEPHrine, O2, IV corticosteroids for anaphylaxis HIGH ALERT
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PHARMACOKINETICS PO: Peak 1-2.5 hr, duration 8-12 hr, half-life 1-11⁄3 hr, metabolized in liver, excreted in urine, crosses placenta, excreted in breast milk, removed by hemodialysis
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• Adult/child >40 kg: 250 mg q8hr or 500 mg q12hr Recurrent/persistent otitis media (Streptococcus pneumoniae, Haemo- philus, Moraxella catarrhalis)
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• Child ≥3 mo: PO 90 mg/kg/day (600 mg amoxicillin/42.9 mg clavula- nate/5 mL) q12hr × 10 days Lower respiratory infections, otitis media, sinusitis, skin/skin structure infections, UTIs
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• Adult: PO 250-500 mg q8hr or 500- 875 mg q12hr, depending on severity of infection
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• Child #40 kg: PO 20-90 mg/kg/day in divided doses q8-12hr Community-acquired pneumonia or acute bacterial sinusitis
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• Adult: PO 2000 mg/125 mg (Augmen- tin XR) q12hr × 7-10 days (pneumonia), 10 days (sinusitis) Renal disease
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• Adult: PO CCr 10-30 mL/min dose q12hr; CCr <10 mL/min dose q24hr; do not use 875-mg strength or ext rel if CCr <30 mL/min; Augmentin XR is contraindi- cated with renal disease
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