Amoxicillin-clavulanic acid aka amoxicillin clavulanate photo
KEY POINTS
- Amoxicillin-calvulanic acid (Augmentin, amox/clav) is the combination of aminopenicillin amoxicillin plus beta-lactamase inhibitor clavulanic acid (aka clavulanate)
- Amoxicillin inhibits cell wall synthesis in susceptible organisms via binding to penicillin-binding-proteins (PBPs), while clavulanic acid prevents amoxicillin from being hydrolyzed by beta-lactamases
- Has activity versus a wide variety of bacteria, including Gram positives, Gram negatives, and anaerobes
- Covers all the organisms amoxicillin alone covers
- Compared to amoxicillin alone, it has better anti-anaerobic, anti-Gram negative, and anti-Gram positive coverage
- Amox/clav has MSSA activity while amoxicillin alone does not
- Amoxicillin can cover penicillin-susceptible Staph aureus (PSSA)
- Amox/clav has activity versus Gram negative anaerobes associated with human and animal bite wounds, making it a go-to drug for this indication
- Does NOT cover Pseudomonas (but piperacillin-tazobactam does)
- Beware resistance in E. coli
- Amox/clav has MSSA activity while amoxicillin alone does not
- Has application for a wide variety of infections including acute otitis media, skin and soft tissue infections, upper respiratory tract infection and more
- Available oral only in USA, available IV in some other countries
- Amox/clav’s IV counterpart in USA is ampicillin-sulbactam
- Available as a pill or suspension
- Requires dosage adjustment for renal insufficiency
- Overall safe and well tolerated
- Beware hypersensitivity reaction and anaphylaxis
- Note that exposure to aminopenicillins during an Epstein Barr Virus (EBV) infection can result in a non-allergic rash that can physically appear similar to an IgE-mediate allergic reaction
- This has led to inappropriate penicillin allergy labels, especially in children
- Penicillin skin testing can assist in ruling out most unclear penicillin allergy labels
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