Trade Names:Augmentin- Tablets 250 mg/125 mg- Tablets 500 mg/125 mg- Tablets 875 mg/125 mg- Chewable tablets 200 mg/28.5 mg- Chewable tablets 400 mg/57 mg- Powder for oral suspension 125 mg/31.25 mg per 5 mL- Powder for oral suspension 200 mg/28.5 mg per 5 mL- Powder for oral suspension 250 mg/62.5 mg per 5 mL- Powder for oral suspension 400 mg/57 mg per 5 mL
Trade Names:Augmentin ES-600- Powder for oral suspension 600 mg/42.9 mg per 5 mL
Trade Names:Augmentin XR- Tablets, extended release 1,000 mg/62.5 mgApo-Amoxi-Clav (Canada)Clavulin (Canada)ratio-Aclavulanate (Canada)
Amoxicillin inhibits bacterial cell wall mucopeptide synthesis. Clavulanic acid inactivates a wide range of beta-lactam enzymes found in bacteria resistant to penicillins and cephalosporins.
Treatment of infections of the lower respiratory tract, otitis media, sinusitis, skin and skin structures, and UTIs caused by susceptible microorganisms.Extended-release (ER) tablets
Acute bacterial sinusitis or community-acquired pneumonia caused by confirmed or suspected beta-lactamase–producing pathogens and Streptococcus pneumoniae with reduced susceptibility to penicillin (MIC equal to 2 mcg/mL).Oral suspension (600 mg/42.9 mg per 5 mL)
Treatment of children with recurrent or persistent acute otitis media due to S. pneumoniae , Haemophilus influenzae , or Moraxella catarrhalis characterized by antibiotic exposure for acute otitis media within the preceding 3 months and who are either 2 yr of age or younger or attend day care.
History of penicillin allergy; history of amoxicillin- and clavulanate-associated cholestatic jaundice or liver disease.ER tablets
Severe renal function impairment (CrCl less than 30 mL/min); hemodialysis patients.
Strengths listed in the following sections are based on amoxicillin content. Because the strengths listed are based on amoxicillin content and the amount of clavulanic acid may differ between products, the dose for various products or dosage forms may not be interchangeable and must be verified before administration.Tablets
Because 250 and 500 mg tablets contain the same amount of clavulanate, two 250 mg tablets are not equivalent to one 500 mg tablet.Adults and children weighing 40 kg or more
PO One 500 mg tablet every 12 h or one 250 mg tablet every 8 h. For more severe infections and infections of the respiratory tract, give one 875 mg tablet every 12 h or one 500 mg tablet every 8 h.
Adult patients with severe renal function impairment (glomerular filtration rate [GFR] 10 to 30 mL/min) should receive 500 or 250 mg every 12 h, depending on severity of infection. Patients with GFR less than 10 mL/min should receive 500 or 250 mg every 24 h, depending on severity of infection. Hemodialysis patients should receive 500 or 250 mg every 24 h, depending on severity of infection. They should receive an additional dose during and at the end of dialysis.ER tablets
Because the ER tablets contain clavulanate 62.5 mg, other tablets cannot be used to provide the same dosages as the ER tablets.Adults and children 16 yr of age and older
PO Recommended daily dose is amoxicillin 4,000 mg and clavulanate potassium 250 mg daily.Acute Bacterial Sinusitis
PO 2 tablets every 12 h for 10 days.Community-Acquired Pneumonia
PO 2 tablets every 12 h for 7 to 10 days.Oral Suspension (other than 600 mg/42.9 mg per 5 mL) and Chewable Tablets
600 mg (5 mL) suspension does not contain the same amount of clavulanic acid as any of the other suspensions (5 mL). Therefore, the suspensions are not interchangeable. Because 250 mg chewable tablets and 250 mg tablets do not contain the same amount of clavulanic acid, they are not interchangeable and should not be substituted for each other.Adults
PO See dose for tablets (listed previously). Adults who have trouble swallowing may be given 125 or 250 mg per 5 mL suspension in place of the 500 mg tablet. The 200 or 400 mg per 5 mL suspension may be used in place of the 875 mg tablet.Children weighing 40 kg or more
PO Dose according to the adult recommendations.Children 12 wk of age and older Otitis media, sinusitis, lower respiratory tract infections, and more severe infections
PO 40 mg/kg/day divided every 8 h or 45 mg/kg/day divided every 12 h.Less severe infections
PO 20 mg/kg/day divided every 8 h or 25 mg/kg/day divided every 12 h.Neonates and infants 12 wk of age and younger
PO 30 mg/kg/day divided every 12 h.Oral Suspension (600 mg/42.9 mg per /5 mL)
This strength does not contain the same amount of clavulanic acid as any of the other suspensions (5 mL). Therefore, the suspensions are not interchangeable.Children 3 mo of age and older
PO 90 mg/kg/day divided every 12 h for 10 days.
Store tablets, chewable tablets, and dry powder for suspension at controlled room temperature (68° to 77°F). Store reconstituted suspension in refrigerator (36° to 46°F). Discard any unused suspension after 10 days.
May increase incidence of rash.Contraceptives, oral
May reduce effectiveness of oral contraceptives.Probenecid
May increase and prolong blood levels of amoxicillin.Tetracyclines
May reduce antibacterial effectiveness of amoxicillin.
May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets (enzyme-based tests [eg, Clinistix , Tes-Tape ] are recommended); false-positive direct Coombs test result in certain patient groups; false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction, and nitric acid test ( Bromphenol Blue Test , Multi-Stix is recommended).
Agitation; anxiety; behavioral changes; confusion; convulsions; dizziness; fatigue; headache; insomnia; reversible hyperactivity.
Skin rashes, urticaria (3%); acute generalized exanthematous rash; erythema multiforme; exanthematous pustulosis; maculopapular to exfoliative dermatitis; pruritus; Stevens-Johnson syndrome (rare); toxic epidermal necrolysis; vesicular eruptions.
Abnormal taste sensation; black, hairy tongue; glossitis; itchy eyes; laryngeal edema; laryngospasm; sore or dry mouth or tongue; stomatitis.
Diarrhea/loose stools (9%); nausea (3%); vomiting (1%); abdominal pain or cramps; anorexia; bloody diarrhea; enterocolitis; epigastric distress; flatulence; gastritis; glossitis; indigestion; mucocutaneous candidiasis; pseudomembranous colitis; rectal bleeding; stomatitis; tooth discoloration.
Vaginitis (1%); crystalluria; interstitial nephritis (eg, hematuria, hyaline casts, oliguria, proteinuria, pyuria); nephropathy.
Agranulocytosis; anemia; bone marrow depression; eosinophilia; granulocytopenia; hemolytic anemia; increased basophils; increased monocytes; increased platelets; increased or decreased lymphocyte count; leukopenia; neutropenia; prolonged bleeding and prothrombin time; reduced hemoglobin or hematocrit; thrombocytopenia; thrombocytopenic purpura.
Cholestatic jaundice; elevated LFTs; hepatitis; increased bilirubin and/or alkaline phosphatase; transient hepatitis.
Reduced albumin; elevated serum alkaline phosphatase and hypernatremia; reduced serum potassium; reduced total proteins and uric acid.
Anaphylaxis; angioedema; hypersensitivity vasculitis; hyperthermia; serum sickness–like reactions (including urticaria, rash, arthritis, arthralgia, myalgia, and fever); superinfection.
Periodically assess organ system function, including renal, hepatic, and hematopoietic function with long-term therapy.Allergic reaction
Monitor patient for signs of anaphylaxis or severe allergic reaction. Discontinue therapy if noted. Be prepared to treat appropriately.Liver enzymes
Ensure liver enzymes are determined before starting therapy and periodically thereafter in patients with hepatic function impairment. Be prepared to discontinue therapy.Sensitivity testing
Review results of culture and sensitivity testing as appropriate. Ensure amoxicillin/clavulanate is discontinued and another antimicrobial agent is started if sensitivity tests indicate that the organism is resistant to amoxicillin/clavulanate.Adverse reactions
Monitor patient for CNS, GI, dermatologic, and general body adverse reactions, and signs of superinfection.Therapy response
Monitor patient's response to therapy.
Category B .
Secreted into breast milk.
Safety and efficacy of 250 mg tablet not established in children weighing less than 40 kg.ER tablets
Safety and efficacy not established in children younger than 16 yr of age.Oral suspension (600 mg/42.9 mg per 5 mL)
Safety and efficacy not established in children younger than 3 mo of age.Oral suspension and chewable tablets
Modify dosage for children younger than 12 wk of age.
Serious and sometimes fatal reactions have been reported in patients on penicillin therapy. Also, there are reports of severe reactions in patients treated with a cephalosporin who have a history of penicillin hypersensitivity.
Dose reduction or every 12 h recommended with severe impairment. Ensure 875 mg tablets and 1,000 mg ER tablets are not used in patient with severe renal function impairment (eg, CrCl less than 30 mL/min).
Use with caution.
May result in overgrowth of nonsusceptible bacterial or fungal organisms.
Safety and efficacy of Augmentin ES-600 not established.
Increased risk of skin rash. Use not recommended.
Contains phenylalanine in 200 and 400 mg chewable tablets, and 200, 400, and 600 mg per 5 mL oral suspensions.
Consider the possibility in patients who develop diarrhea.
Crystalluria, which may lead to renal failure; diarrhea; drowsiness; hyperactivity; interstitial nephritis, resulting in oliguric renal failure; rash; stomach and abdominal pain; vomiting.
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