Amoxicillin-Clavulanate

C difficile risk
Medium
Oral Bioavailability
Good (70 to 90%)
Cost
$ 0.87/day (PO) $12.00 day (IV)

Dosing

500mg PO TID of the amoxicillin component

Alternate Option

  • 875 mg PO BID

  • 875 mg tabs may be difficult to swallow

Dosing based on Amoxicillin component

For most indications

  • 1g IV q8h

Alternative regimen

  • 2g IV q12h if CrCL > 30 mL/min

For severe/life threatening infections

  • 2g IV q8h

eGFR 0 - 10eGFR 10 - 30eGFR 30 - 50eGFR > 50Dose based on amoxicillin componentPO: 250-500mg amox component q24h

IV: 1g initially followed by 500 mg q12-24h
Do not use 10:1 (2g) formulation250-500mg PO amox component q12h

IV: 1g initially followed by 500 mg q12h
Do not use 10:1 (2g) formulationPO: 250-500mg PO amox component q12h

IV: no dose reduction necessary500mg PO amox component q8h

IV: No dose reduction necessary

Dose based on amoxicillin componentPO

  • 250-500mg PO amox component q24h

  • Give after dialysis on dialysis days

IV

  • 1g initial dose followed by 500 mg q24h;

  • Give dose after dialysis on dialysis days OR give supplemental dose of 500 mg at end of dialysis

Do not use 10:1 (2g) formulation

General Information

Prophylaxis/treatment of bite wounds.

Polymicrobial infections of the respiratory tract or abdomen.

Skin and soft tissue infections.

For prolonged therapy, monitor liver enzymes and function.

  •  Allergy/rash (immediate or delayed)

  •  Note EBV related rash

  •  Cytopenias

  •  Diarrhea

  •  Hepatotoxicity due to clavulanate - usually mild, liver failure is rare.

Increased risk of rash with allopurinol

EH Prescribing Restrictions:

  • None

Tablets can be crushed and given via NG tube; Liquid also available

Bioavailability:

  • Bioavailability classification based on Amoxicillin component

  • Clavulanic acid bioavailability varies from 30-98%

Available Strengths (IV):

  • 5:1 ratio Amoxicillin/Clavulanate (500 mg/100 mg and 1000 mg/200 mg)

  • 10:1 ratio Amoxicillin/Clavulanate (2000 mg/200 mg)

THE 10:1 AND 5:1 PRODUCTS ARE NOT INTERCHANGEABLE

Using 2g vial for smaller doses will result in underdosing of clavulanic acid

Using 500 mg or 1g vial for larger doses will overdose clavulanic acid, causing potentially severe GI Side effects

Administration:

  • Reconstitute 500 mg vials with 10 mL Sterile water for injection (SWI), 1g and 2g vials with 20 mL SWI. Further dilute 500 mg doses in 50 mL NS, administer over 30 min.

1g and 2g doses should be diluted in 100 mL NS and infused over 30 minutes

Use promptly once reconstituted; once diluted in NS solutions are stable for 60 minutes at room temperature, 4 hrs refrigerated

Community IV (St. John's metro):

  • NO (Limited stability)

  • Open Benefit

  • No prescribing restrictions

Antimicrobial class: Aminopenicillin + Beta-lactamase inhibitor

Pregnancy category: B

Average serum half life: 1 hour

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic