|
|
Paul A. Pham Pharm.D. and John G. Bartlett M.D.
12-14-2009
-
Available formulation in Zambia: amoxicillin + clavulanate tablet: 625 mg (500 mg + 125 mg); 375 mg (250 mg + 125mg).
- Uncomplicated UTI in pregnant pts:amoxicillin/clavulanic acid 375 mg PO q8h x 7 days.
- Aspiration pneumonia in clinically stable pts: amoxicillin/clavulanic acid 375 mg q8h.
Zambia Information Author: Paul A. Pham Pharm.D.
- Lymphadenitis
- Mastitis
- Otitis media
- Pharyngitis
- Community-acquired pneumonia (XR formulation)
- Acute bacterial sinusitis (XR and IR formulations)
- Skin and skin-structure infections (carbuncles, cellulitis, subcutaneous abscess)
- Tonsillitis
- Urinary-tract infection
- Sinusitis, Acute
- Lung Abscess
- Empyema
- Pyomyositis
- Bite wound (human, dog and cat)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Augmentin | Amoxicillin + Clavulanate | ~GlaxoSmithKline | PO
susp
125mg/31.25mg per 5mL | $1.50 per 5mL |
|
|
|
| PO
susp
250mg/62.5mg per 5mL | $2 per 5mL |
|
|
|
| PO
susp
400mg/57mg per 5mL | $3.52 per 5 mL |
|
|
|
| PO
susp
600mg/42.9mg per 5mL | $2.95 per 5 mL |
|
|
|
| PO
chew tab
125:31 | $1.5 |
|
|
|
| PO
chew tab
250:62 | $3 |
|
|
|
| PO
tab
250:125 | $3 |
|
|
|
| PO
tab
500:125 | $4.39 |
|
|
|
| PO
tab
875:125 | $5 |
|
|
|
| IV
vial
500:100 | Not available in the US |
|
|
|
| IV
vial
1000:200 | Not available in the US |
| Augmentin ES | Amoxicillin + Clavulanate | GlaxoSmithKline | PO
suspension
600mg/42.9mg per 5mL (75mL, 125mL, 200mL) | $3.62 per 5mL |
| Augmentin XR | amoxicillin + clavulanate | GlaxoSmithKline | Oral
tab, XR
1000mg/62.5mg | $4.10 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
. 875/125 mg PO twice-daily . .
- 250-1000 mg PO three times daily.
- 875/125 mg PO twice-daily.
- XR: 2 tablets (2000mg:125mg) PO twice-daily.
Usual dose.
GFR 10-30 ml/min: 0.25gm-0.5gm q12h. GFR >30 ml/min: usual dose.
0.25gm-0.5gm q24h.
0.25gm-0.5gm q24h (XR product not recommended in HD).
Usual regimen.
No data. Consider 0.5 gm q12h.
- GI intolerance and diarrhea
- Rash (especially if administered in setting of infectious mononucleosis)
-
C. difficile colitis
- Hypersensitivity reactions
- Jarisch-Herxheimer reaction with spirochetal infection
- Drug Fever
- Coombs' test positive, hemolytic anemia
- Leukopenia and thrombocytopenia
- CNS-seizures and twitching ( with high doses in patients with renal failure)
- Interstitial nephritis
- LFTs elevation
- Allopurinol: may increase the risk of rash
- Oral contraceptives: may decrease the efficacy of OCs. Use an additional form of contraception.
-
Tetracyclines: avoid concurrent administration. In two studies involving a total of 79 patients with pneumococcal meningitis treated with either penicillin plus tetracyclines or penicillin monotherapy resulted in a higher mortality rate (79-85%) in the combination therapy compared to penicillin monotherapy (30-33%).(Arch Intern Med 1951:88:489, Ann Intern Med 1961; 55:545). However there was not a higher mortality rate between penicillin monotherapy and penicillin plus tetracycline in the treatment of pneumococcal pneumonia.(Arch Intern Med 1953; 91:197).
- PCN Resistant break point: >.12 mcg/mL for S. pneumoniae meningitis, but > 2 mcg/mL for S. pneumoniae pneumonia.
-
S. pneumoniae : PCN resistance rate was 10.3% (using resistant break point 2 mcg/mL), but only 1.2% (using MICs of 8 mcg/mL). Without meningeal involvement, S. pneumoniae with MIC of 2 mcg/mL or lower can be treated with high dose PCN or amox/clavulanate (4 gm/day) [CID 2005; 41: 139-48 ].
Oral beta-lactam w/ activity against common bacteria that produce beta-lactamases, e.g., H. influenzae, MSSA, Moraxella and all PCN-resistant anaerobes. Diarrhea is common due to both clavulanate and amoxicillin. The IDSA recommends amox/clav if anaerobes or H. influenzae are suspected [CID 2007 44 Suppl 2:S27-72.]. No advantage using Augmentin XR over amoxicillin 1g PO q8h for intermediately-resistant S. pneumoniae since reduced susceptibility to penicillin by the pneumococcus is mediated by an alteration in the penicillin binding protein (PBP), therefore the addition of clavulanate, a beta-lactamase inhibitor, offers no benefit to high dose amoxicillin.
- Mandell LA, Wunderink RG, Anzueto A, et al. ;
Community-Acquired Pneumonia in Adults: Guidelines for Management ;
Clinical Infectious Diseases ;
2007 ; Vol.
44 ; pp.
S27â??S72 ;
PUBMED: 17278083
Rating:
Basis for recommendation
Comments:Amoxicillin 1 g q8h OR amoxicillin-clavulanate 2 g q12h plus a macrolide is the preferred outpatient treatment regimen in pts at risk for drug resistant (DRSP). Pts with chronic illness, alcoholism, and abx within the last 3 months are at risk for DRSP. For the treatment of PCN-resistant S. pneumoniae , there is no advantage of using high dose amoxicillin/clavulanate over high dose amoxicillin, but if anaerobes or are suspected amox/cla should be considered.
|
|
![Johns Hopkins POC-IT: Point of Care Information Technology [Home]](/images/pocit_logo.gif){kind=logo}
Help
