Amoxicillin-clavulanate

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Amoxicillin/clavulanic acid (INN) or co-amoxiclav (BAN) is a combination antibiotic consisting of amoxicillin trihydrate, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor. This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.

Unlike co-trimoxazole, the BAN has not been widely adopted internationally. Trade names include Augmentin (by GlaxoSmithKline),[1] Clavamox (by Pfizer), and many others.

Medical uses

Amoxicillin/clavulanic acid is widely used to treat many infections caused by susceptible bacteria, such as urinary tract infections, respiratory tract infections, skin and soft tissue infections, and infections caused by the bacterial flora of the mouth, such as dental infections, infected animal bites, and infected human bites (including uncomplicated "clenched-fist" or "reverse-bite" injuries).[1][2]

Adverse effects

Possible side effects include diarrhea, vomiting, nausea, thrush, and a skin rash. These do not usually require medical attention. As with all antimicrobial agents, antibiotic-associated diarrhea due to Clostridium difficile ("C. diff'") infection—sometimes leading to pseudomembranous colitis—may occur during or after treatment with amoxicillin/clavulanic acid.[2]

Rarely, cholestatic jaundice (also referred to as cholestatic hepatitis, a form of liver toxicity) has been associated with amoxicillin/clavulanic acid. The reaction may occur up to several weeks after treatment has stopped, and usually takes weeks to resolve. It is more frequent in men, older people, and those who have taken long courses of treatment; the estimated overall incidence is 1 in 100,000 exposures.[2] In the United Kingdom, co-amoxiclav carries a warning from the Committee on Safety of Medicines to this effect.[1]

As all aminopenicillins, amoxicillin has been associated with Stevens–Johnson syndrome/toxic epidermal necrolysis, although these reactions are very rare.[2][3]

History

The combination was invented around 1977/78 by British scientists working at Beecham (now part of GlaxoSmithKline), which filed for US patent protection for the drug combination in 1979. A patent was granted in 1984.[4] Augmentin is the original name used by its inventor.

Preparations

Many branded products indicate their strengths as the quantity of amoxicillin. Augmentin 250 for example contains 250 mg of amoxicillin and 125 mg of Clavulanic acid.[1][5]

An intravenous preparation has been available in the UK since 1985,[6] but there is no parenteral preparation available in the US; the nearest equivalent is ampicillin/sulbactam.

Suspensions of amoxicillin/clavulanic acid are available for use in children. They must be refrigerated to maintain effectiveness.

Veterinary use

The amoxicillin/clavulanic acid combination is also used in the treatment of, among other infections, periodontitis and kennel cough[7][8] in dogs; urinary tract infections, skin and soft tissue infections in cats; enteritis and navel ill in calves; respiratory tract infections, soft tissue infections, metritis and mastitis in cattle; respiratory tract infections, colibacillosis, mastitis, metritis and agalactia in pigs. In combination with prednisolone it is used for intra-mammary infusion for the treatment of mastitis in lactating cows. Trade names include Clavaseptin, Clavamox and Synulox.

Amoxicillin/clavulanic acid is banned from use in domestic-food animals (cattle, swine, etc.) in both the US and Europe, in the UK synulox can be used in "domestic-food animals" as long as a specified withdrawal period is adhered to.

Bacterial resistance

Bacterial antibiotic resistance is a growing problem in veterinary medicine. Amoxicillin/clavulanic acid is reported to be effective against clinical Klebsiella infections, but is not efficacious against Pseudomonas infections.[9]

Bold text==Trade names==

  • Alviclav 625 (Alvis Health Care; India)
  • Amoclav (Rowex Ltd., Ireland)
  • Amoklavin-BID (deva, Turkey)
  • Amoksiklav (by Novartis Slovenia, Serbia, Bulgaria)
  • Amorion Comp (by Orion Corporation Finland)
  • AMOX/K CLAV (875 mg, Sandoz; US)
  • Amoxi Clav (Canada)
  • Amoxicilina-Clavulánico (Spain)
  • Amoxicillin-clavulanate (rINN)
  • Amoxicilline-clavulanique (France)
  • Amoxiclav (by Teva; Belgium, Israel)
  • Amoxycillin-clavulanate (US)
  • AugMaxcil (Triomed; South Africa)
  • Augmentin (GlaxoSmithKline [originally Beecham]; Hungary; Pakistan, Romania, Philippines; United States, Australia)
  • Augpen (Zuventus; India)
  • Clamovid (Hovid)
  • Clamoxyl Duo Oral Suspension (Australia)
  • CLAMP (Dr. Reddy's, India)[10]
  • Clavamox (Sandoz, Austria)
  • Clavituf (Intas, India)
  • Clavulin (Canada, Brazil)
  • Co-amoxiclav (UK, KSA, Ireland, South Africa, Iran)
  • Curam (Singapore)
  • Clavam (Alkem Laboratories Ltd; India)
  • Enhancin (Ranbaxy, Malaysia)
  • Fleming (Medreich, India)
  • Finemox (Finecure, India)[11]
  • Forcid (Astellas)
  • Julmentin 2x (Julphar; Egypt; UAE)
  • Klamentin (CTCP Duoc Hau Giang, Vietnam)
  • Klamoks ( Bilim Pharmaceuticals, Turkey)
  • Klavocin (Pliva - Croatia)
  • Klavon ( Bilim Pharmaceuticals, Turkey)
  • Mega-CV (Aristo, India)
  • Magnabiotic (Egypt, Sedico)
  • MoxClav (Ranbaxy, India)
  • Moxiclav Duo (Australia)
  • Moxikind (Mankind Pharma, India)
  • Noroclav (Norbrook, UK)
  • Panklav (Hemofarm - Serbia)
  • Polyclav 625 (India)
  • Sinergia (LIFE, Ecuador)
  • Ratio Aclavulanate 500/125 (Canada)
  • xcilan (ovia pharma pvt. ltd. India)
  • Xiclav (GL-Pharma, Austria)
  • Аугментин (Russia)
  • Zakutex (South Korea)

References

  • http://www.merckmanuals.com/professional/print/lexicomp/amoxicillin%20and%20clavulanate%20potassium.html

External links

  • GlaxoSmithKline
  • http://www.laboratorioslife.com/index.php?option=com_producto&Itemid=87&task=listaProductosHumana&lang=en
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