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Co-amoxiclav
Combination of
Amoxicillin Penicillin antibiotic
Potassium clavulanate Beta-lactamase inhibitor
Identifiers
CAS number 74469-00-4
ATC code J01CR02
PubChem 6435924
Therapeutic considerations
Pregnancy cat. B(US)
Legal status POM (UK) -only (US)
Routes oral, iv

Co-amoxiclav is the British Approved Name for the combination antibiotic containing amoxicillin trihydrate, a β-lactam antibiotic, with 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.

This name, unlike co-trimoxazole, has not been widely adopted internationally and the combination product is usually referred to by various names such as amoxicillin with clavulanic acid or amoxicillin+clavulanate or simply by a trade name such as EXCLAV (by NeoMedD), HECLAV-625 (by Mascot),Twinox (by USV) CLAMP (by FGP), Synermox, Augmentin (by GlaxoSmithKline formerly Beecham),[1] Cavumox (Thailand) Clavamox (for veterinary use by Pfizer), TORMOXIN CLAV (India) or Clavamel.

Contents

History

Co-amoxiclav was invented around 1977/78 by British scientists working at Beecham, which filed for US patent protection for the drug combination in 1979. US patent 4441609 was granted in 1984.

Dosage

The proportions of the two constituents are expressed as x/y where x and y are the strengths in milligrams of amoxicillin and clavulanic acid respectively. However, the branded products indicate their strengths as the quantity of amoxicillin, hence co-amoxiclav 250/125 ≡ Augmentin 250 and contains 250 mg of amoxicillin with 125 mg of clavulanic acid.[1][2]

Standard adult curable dosages for respiratory tract, susu, abdominal, and dent infections as well as cellulitis and animal bites is co-amoxiclav 250/125 (one tablet Augmentin 250) taken every 8 hours, which may be doubled in severe infections (as a single tablet of co-amoxiclav 500/125 ≡ Augmentin 500, but not as two co-amoxiclav 250/125 tablets which would double the maximum recommended dose of clavulanic acid). In the US, Augmentin XR (co-amoxiclav 1000/62.5) is marketed for use in community acquired pneumonia with two tablets taken twice a day (giving 4000 mg total daily dose of amoxicillin).

From the prescribing information for Augmentin,[2] the usual adult dose is one 500-mg tablet of Augmentin every 12 hours or one 250-mg tablet of Augmentin every 8 hours. For more severe infections and infections of the respiratory tract, the dose should be one 875-mg tablet of Augmentin every 12 hours or one 500-mg tablet of Augmentin every 8 hours.

Dosages for children are also given three times a day using suspensions containing co-amoxiclav 250/62 in each 5 mL (Augmentin '250/62 SF') for those between the ages of 6–12 years and co-amoxiclav 125/31 (Augmentin '125/31 SF') for those between the ages of 1–6 years. A more concentrated solution, co-amoxiclav 400/57 (Augmentin '400/57 SF'), may be administered more conveniently just twice daily to children from as young as 2 months of age; quantities are based on body weight with 2.5 mL from the age of 2 years and 5 mL after the age of 6 years.

An intravenous preparation of Co-amoxiclav has been available in the UK since 1985,[3] but there is no parenteral preparation available in the US: the nearest equivalent is ampicillin-sulbactam.

Side effects

Amongst the possible side-effects of this medication are diarrhea, vomiting, thrush, and a few other conditions. These do not usually require medical attention. However, if the patient experiences an allergic reaction to the medication, jaundice, fever, or severe diarrhea, it is necessary to contact a doctor immediately. As with all antimicrobial agents, pseudomembranous colitis has been associated with the use of amoxicillin-clavulanate. Amoxicillin is a member of the penicillin family of antibiotics, and therefore should not be taken by patients allergic to penicillin.

Veterinary use

The amoxicillin/clavulanic acid combination is also used in the treatment of, among other infections, periodontitis in dogs and skin infections in cats. The preparation for veterinary use is commonly marketed under the trade names Clavaseptin, and Clavamox. Amoxicillin/clavulanic acid is banned from use in domestic-food animals (cattle, swine, etc.) in both the US and Europe.

Storage notes

Liquid co-amoxiclav must be refrigerated to maintain effectiveness.

Synonyms

  • Twinox (USV-India)
  • CLAMP (Dr Reddy's - India)- FGP
  • Amoclan (Hikma Pharmaceuticals-Jordan)
  • Amoxycillin-clavulanate (US)
  • Amoxicillin-clavulanate (rINN)
  • Amoxicilline-clavulanique (France)
  • Amoxiclav Sandoz (Belgium)
  • Augmentin (GlaxoSmithKline; originally Beecham, 1981)
  • CalamoX(Pakistan - Bosch)
  • Clamoxin (Mexico)
  • Co-amoxiclav (UK)
  • Klavocin (Croatia)
  • Xiclav (Bosnia and Herzegovina)
  • FlemiClav (FDC - India)
  • Amoclav (Techno Drugs - Bangladesh)
  • Amoksiklav (Sandoz Romania )
  • Exten (Zynova-Philippines)

References

  1. ^ a b British National Formulary (54 ed.). September 2007.  
  2. ^ a b "Augmentin -- Prescribing Information" (PDF). GlaxoSmithKline. December 2006. http://us.gsk.com/products/assets/us_augmentin.pdf. Retrieved 2008-01-28.  
  3. ^ Davies BE, Boon R, Horton R, Reubi FC, Descoeudres CE (1988). "Pharmacokinetics of amoxycillin and clavulanic acid in haemodialysis patients following intravenous administration of Augmentin" (PDF & scanned). Br J Clin Pharmacol 26 (4): 385–90. PMID 3190988. PMC 1386558. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3190988.  

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