Amoxicillin clavulanate 125 mg

Distribution: Distributed into pleural peritoneal and synovial fluids and into the lungs, prostate, muscle, liver, and gallbladder; it also penetrates middle ear, maxillary sinus and bronchial secretions, tonsils, and sputum. Amoxicillin readily crosses the placental barrier; about 17% to 20% is protein-bound.

Excretion: Excreted mainly in urine by renal tubular secretion and glomerular filtration; also excreted in breast milk.

Elimination half-life in adults is about 1 to 1 1/2 hours; severe renal impairment increases half-life to 7 1/2 hours.

Contraindications and precautions Contraindicated in patients hypersensitive to drug or other penicillins.

Allopurinol: Increases risk of rash from both drugs. Hormonal contraceptives: May decrease effectiveness of

hormonal

Probenecid: Blocks renal tubular secretion of amoxicillin, raising its serum level.

Khat: May decrease antimicrobial effect of certain penicillins.

Discourage khat chewing, or tell patient to take amoxicillin 2 hours after chewing khat. Adverse reactions CNS: lethargy, hallucinations, seizures, anxiety, confusion, agitation, depression, dizziness, fatigue.

GI: nausea, vomiting, diarrhea, glossitis, stomatitis, gastritis, abdominal pain, enterocolitis, pseudomembranous colitis, black "hairy"

tongue

GU: interstitial nephritis, nephropathy, vaginitis. Hematologic: anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, hemolytic anemia, agranulocytosis. Other: amoxicillin 500mg ebay hypersensitivity reactions (erythematous maculopapular rash, urticaria, anaphylaxis ), overgrowth of nonsusceptible organisms. Effects on lab test results ? May increase eosinophil count.

May decrease hemoglobin and granulocyte, platelet, and WBC counts.

Overdose and treatment Overdose may cause neuromuscular sensitivity or seizures. After recent ingestion (4 hours or less), empty the stomach by induced emesis or gastric lavage; follow with activated charcoal to reduce absorption. Special considerations ? Amoxicillin may alter results of urine glucose tests that use cupric sulfate (Benedict’s reagent or Clinitest). Make urine glucose determinations with glucose oxidase methods (Chemstrip uG, Diastix, or glucose enzymatic test strip). ? Monitor renal, hepatic, and hematologic tests if patient receives prolonged therapy.

? 200-mg and 400-mg chewable Amoxil tablets contain aspartame and shouldn’t be given to patients with phenylketonuria.

? Oral dosage is maximally absorbed from an empty stomach, but food doesn’t cause significant loss of potency.

? Suspension and drops are stable for 14 days in refrigerator after reconstitution. ? Amoxicillin may cause less diarrhea than ampicillin. Pregnant patients ? There are no adequate controlled studies in pregnant women, but drug has been used effectively without evidence of adverse effects. Breast-feeding patients ? Drug appears in breast milk; safe use in breast-feeding women hasn’t been established. Recommend an alternative to breast-feeding during therapy.

Pediatric patients ? Pediatric drops may be placed on child’s tongue or added to formula, milk, fruit juice, or soft drink. Geriatric patients ? Because of diminished renal tubular secretion, half-life may be prolonged in geriatric patients.

Patient education ? Tell patient to chew chewable tablets thoroughly or crush before swallowing and wash down with liquid to ensure adequate absorption of drug; capsule may be emptied and contents swallowed with water.

? Instruct patient to complete full course of medication. Reactions

may

Amoxicillin+clavulanic acid should be reserved for treatment of infections where amoxicillin alone is ineffective due to inactivation by beta lactamase enzymes.

It may be used to rationalise antibiotics when infants are receiving amoxicillin and require additional cover against staphylococci that would normally be provided by adding flucloxacillin.

Previous history of jaundice / hepatic dysfunction associated with Augmentin (or amoxicillin/clavulanic acid combination).

mild renal impairment : no change to dosing schedule; moderate renal impairment : increase the dosing interval.

Maintain adequate fluid intake, especially with IV doses, to reduce the possibility of amoxicillin crystalluria.

Cholestatic jaundice – although rarely reported in children.

Oral suspension - contains aspartame (source of phenylketonuria) , therefore use with caution in patients with phenylketonuria. The clavulanic acid component protects the amoxicillin from degradation by beta-lactamases, thus extending the spectrum of the amoxicillin.

Oral absorption is enhanced by the presence of food. Diarrhoea and vomiting, review therapy if this occurs.

Hepatic events - although rarely reported in children.

Consult with ID service for use greater than 14 days.

CNS toxicity with high doses or severe renal impairment. Monitor : renal & hepatic function and FBC if on prolonged therapy. Antibiotic prescribing guidelines establish standards of care, focus quality improvement efforts, and improve patient

outcomes

The table below summarizes the most recent principles of appropriate antibiotic prescribing for children obtaining care in an outpatient setting for the following six diagnoses: acute rhinosinusitis, acute otitis media, bronchiolitis, pharyngitis, common cold, and urinary tract infection. A bacterial diagnosis may be established based on the presence of one of the following criteria: Persistent symptoms without improvement: nasal discharge or daytime cough >10 days.

Worsening symptoms: worsening or new onset fever, daytime cough, or nasal discharge after initial improvement of a viral URI. Severe symptoms: fever ?39°C, purulent nasal discharge for at least 3 consecutive days. Imaging tests are no longer recommended for uncomplicated cases.

Amoxicillin, a member of the penicillin family of antibiotics, is used to treat bacterial infections , including infections of the middle ear .

The combination of amoxicillin/clavulanate (Augmentin) is an extended-spectrum antibiotic used to treat bacterial infections resistant to amoxicillin alone.

Common brand names: Summary of Interactions with Vitamins, Herbs, & Foods. Tetracycline can interfere with the activity of folic acid , potassium , and vitamin B2 , vitamin B6 , vitamin B12 , vitamin C , and vitamin K .

This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation.

Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. Taking large amounts of niacinamide, a form of vitamin B3 , can suppress inflammation in the body.

According to numerous preliminary reports, niacinamide, given in combination with tetracycline or minocycline , may be effective against bullous pemphigoid, a benign, autoimmune blistering disease of the skin.

Preliminary evidence also suggests a similar beneficial interaction may exist between tetracycline and niacinamide in the treatment of dermatitis herpetiformis . Tetracycline can interfere with

the

This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation.

Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. Taking large amounts of niacinamide, a form of vitamin B3 , can suppress inflammation in the body. According to numerous preliminary reports, niacinamide, given in combination with tetracycline or minocycline , may be effective against bullous pemphigoid, a benign, autoimmune blistering disease of the skin. Preliminary evidence also suggests a similar beneficial interaction may exist between tetracycline and niacinamide in the treatment of dermatitis herpetiformis . Neomycin can decrease absorption or increase elimination of many nutrients, including calcium , carbohydrates, beta-carotene , fats, folic acid , iron , magnesium , potassium , sodium, and vitamin A , vitamin B12 , vitamin amoxicillin in dentistry D , and vitamin K . Surgery preparation with oral neomycin is unlikely to lead to deficiencies.

It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

Tetracycline can interfere with the activity of folic acid , potassium , and vitamin B2 , vitamin B6 , vitamin B12 , vitamin C , and vitamin K .

This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.

Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics.

Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K. A common side effect of antibiotics is diarrhea , which may be caused by the elimination of beneficial bacteria normally found in the colon.

A nonpathogenic yeast known as Saccharomyces boulardii has been shown in two double-blind studies to decrease frequency of diarrhea in people taking amoxicillin as well as other penicillin-type drugs compared to placebo.

There were overall few people in these studies using amoxicillin specifically, so there is no definitive proof that Saccharomyces boulardii will be beneficial for everyone when it is combined with amoxicillin.

The studies used 1 gram of Saccharomyces boulardii per day. A separate double-blind study found that taking a combination of Lactobacillus acidophilus and Lactobacillus bulgaricus, two normal gut bacteria, with amoxicillin did not protect children from developing diarrhea. The authors of the study point out some problems such as the parents' inability to consistently define diarrhea. However, at this time, it is unknown if lactobacillus products will reduce diarrhea due to amoxicillin. Controlled studies have shown that taking other probiotic microorganisms—such as Lactobacillus casei , Bifidobacterium longum , or Lactobacillus rhamnosus GG —also helps prevent antibiotic-induced diarrhea. The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile , which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker's or brewer's yeast)—helps prevent recurrence of this infection. Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina ( candida vaginitis ) and the intestines (sometimes referred to as "dysbiosis").

Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis. Tooth discoloration is a side effect of minocycline observed primarily in young children, but it may occur in adults as well. Vitamin C supplementation may prevent staining in adults taking minocycline.

A common side effect of antibiotics is diarrhea , which may be caused by the elimination of beneficial bacteria normally found in the colon.