Active substanceAmoxicillin + Clavulanic acidAmoxicillin + Clavulanic acid
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  • Dosage form: & nbsppowder for solution for intravenous administration
    Composition:

    Per 1 bottle:

    Active substances: amoxicillin 1000.0 mg, in the form of amoxicillin sodium 1060.0 mg, clavulanic acid 200.0 mg, in the form of potassium clavulanate 237.8 mg.

    Description:White or almost white with a yellowish tinge fine crystalline hygroscopic powder.
    Pharmacotherapeutic group:Antibiotic - penicillin semisynthetic + beta-lactamase inhibitor
    ATX: & nbsp

    J.01.C.R.02   Amoxicillin in combination with enzyme inhibitors

    Pharmacodynamics:

    Amoxicillin is a semisynthetic aminopenicillin, belonging to the group of beta-lactam antibiotics, which has a broad spectrum of antibacterial activity against many Gram-positive and Gram-negative microorganisms. Amoxicillin is destroyed by the action of microbial enzymes (beta-lactamases) and does not affect the microorganisms that produce these enzymes.

    Clavulanic acid is a beta-lactam, structurally related to penicillins, which has the ability to inactivate beta-lactamases. The presence of clavulanic acid protects amoxicillin from the destructive effect of beta-lactamases and effectively expands the spectrum of amoxicillin activity, which includes many bacteria, usually resistant to amoxicillin,as well as to other penicillins and cephalosporins.

    Amoxicillin + clavulanic acid has a bactericidal effect in vivo on the following microorganisms:

    Gram-positive aerobes: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes.

    Gram-negative aerobes: Enterobacter spp., Escherichia coli. Haemophilus influenzae, Klebsiella spp., Moraxella catarrhalis.

    Amoxicillin + clavulanic acid has a bactericidal effect in vitro on the following microorganisms:

    Gram-positive aerobes: Bacillis anthracis, Corynebacterium spp.; Enterococcus faecalis, Enterococcus faecium, Listeria monocytogenes, Nocardia asteroids, coagulase-negative staphylococci, Staphylococcus epidermidis, Streptococcus agalactiae, Streptococcus spp. groups viridans.

    Gram-positive anaerobes: Clostridium spp., Peptococcus spp., Peptostreptococcus spp.

    Gram-negative aerobes: Bordetella pertussis, Brucella spp., Gardnerella vaginalis, Helicobacter pylori, Legionella spp., Neisseria gonorrhoeae, Neisseria meningitidis, Pasteurella multocida, Proteus mirabilis, Proteus vulgaris, Salmonella spp., Shigella spp., Vibrio cholerae, Yersinia enterocolitica.

    Gram-negative anaerobes: Bacteroides spp. (incl. Bacteroides fragilis) species of genus Fusobacterium spp.

    Other: Borrelia burgdorferi, Chlamydiae spp., Leptospira icterohaemorrhagiae, Treponema pallidum.

    Pharmacokinetics:

    Amoxicillin and clavulanic acid in combination do not affect the pharmacokinetics of each other. The maximum plasma concentration after bolus injection of amoxicillin + clavulanic acid (1000 mg + 200 mg) is 105 mg / l for amoxicillin and 28 mg / l for clavulanic acid. The half-life of amoxicillin 1000 mg is 0.9 hours, clavulanic acid 200 mg - 0.9 hours.After intravenous administration, therapeutic concentrations of amoxicillin and clavulanic acid are created in the abdominal cavity, fat and muscle tissues and interstitial fluid, in the skin, lungs and pleural fluid, in the gallbladder, as well as in synovial and peritoneal fluids, bile and pus.

    Amoxicillin and clavulanic acid penetrate the placental barrier and in low concentrations are excreted into breast milk. Amoxicillin and clavulanic acid bind to plasma proteins by 13-20%.

    Amoxicillin is excreted mainly by the kidneys, whereas clavulanic acid is through both renal and extrarenal mechanisms. Approximately 60-70% of amoxicillin and 40-65% of clavulanic acid are excreted by the kidneys unchanged in the first 6 hours after one bolus injection of 1000 mg / 200 mg. Amoxicillin in an amount equivalent to 10-25% of the initial dose of amoxicillin, is excreted by the kidneys in the form of inactive penicillic acid. Clavulanic acid in the human body is subject to intensive metabolism and is excreted by the kidneys and intestines, as well as with exhaled air.

    Indications:

    Bacterial infections,caused by microorganisms sensitive to the preparation:

    - Infections of the lower respiratory tract (exacerbation of chronic bronchitis, lobar pneumonia and bronchopneumonia);

    - Infections of the ENT organs (otitis media, sinusitis, relapsing tonsillitis)

    - Urinary tract infections (including cystitis, urethritis, pyelonephritis);

    - Infections of the pelvic organs (including salpingitis, salpingoophoritis, endometritis, septic abortion, pelvic peritonitis, postpartum sepsis);

    - Infections of the skin and soft tissues (phlegmon, wound infection, erysipelas, impetigo, abscesses);

    - Infections of bones and joints (including chronic osteomyelitis);

    - Sexually Transmitted Infections (Gonorrhea);

    - Other infectious diseases: septicemia, peritonitis, intra-abdominal sepsis, postoperative infections.

    Prevention of postoperative infections, with surgical interventions on the gastrointestinal tract, pelvic organs, head and neck, heart, kidneys, bile ducts, as well as implantation of artificial joints.

    Contraindications:

    - Hypersensitivity to amoxicillin and clavulanic acid;

    - increased sensitivity to penicillins, cephalosporins, other beta-lactam antibiotics;

    - Infectious mononucleosis;

    - episodes of jaundice or impaired liver function as a result of amoxicillin / clavulanic acid in history.

    Carefully:

    Hepatic insufficiency, diseases of the gastrointestinal tract (including colitis in history, associated with the use of penicillins), chronic renal failure (creatinine clearance <30 ml / min).

    Pregnancy and lactation:

    The use of the drug during pregnancy is possible only in cases where the intended benefit to the mother exceeds the potential risk to the fetus. If you need to use the drug during lactation, you should decide whether to stop breastfeeding.

    Dosing and Administration:

    The drug is administered intravenously (IV).

    The dosage regimen depends on the age, body weight and function of the patient's kidneys, and also on the severity of the infection.

    The minimum course of antibiotic therapy is 5 days. The maximum duration of therapy can be 14 days, after which its effectiveness and tolerability should be assessed.

    Doses are given for the content of amoxicillin / clavulanic acid.

    Adults and children older than 12 years weighing more than 40 kg

    Infections of mild and moderate severity: 1000 mg / 200 mg every 8 hours.

    Severe infections: 1000 mg / 200 mg every 4-6 hours.

    Prophylaxis in surgery

    Interventions lasting less than 1 hour; 1000 mg / 200 mg during the initial anesthesia Interventions lasting more than 1 hour: 1000 mg / 200 mg during the initial anesthesia and then to 4 doses of 1000 mg / 200 mg for 24 hours.

    Patients with impaired renal function

    Dose adjustment is based on the maximum recommended dose of amoxicillin.

    Creatinine clearance> 30 ml / min

    Correction of dose is not required

    Creatinine clearance 10-30 ml / min

    Initially, 1000 mg / 200 mg and further 500 mg / 100 mg twice daily

    Creatinine clearance <10 ml / min

    Initially 1000 mg / 200 mg and further 500 mg / 100 mg every 24 hours

    Patients on hemodialysis

    Dose adjustment is based on the maximum recommended dose of amoxicillin.

    Initially, a dose of 1000 mg / 200 mg, followed by 500 mg / 100 500 mg / 100 mg at the end of the hemodialysis session (for amoxicillin and clavulanic acid in plasma) is administered.

    Patients with impaired hepatic function

    Treat with caution; regularly monitor liver function.

    Children

    For children weighing less than 40 kg, the dose is calculated depending on the body weight.

    Less than 3 months with a body weight of less than 4 kg (25 mg / 5 mg) / kg every 12 hours.

    Less than 3 months with a body weight of more than 4 kg (25 mg / 5 mg) / kg every 8 hours.

    In children younger than 3 months, the drug should be injected only slowly infusion for 30-40 minutes.

    From 3 months to 12 years

    (25 mg / 5 mg) / kg every 6-8 hours, depending on the severity of the infection.

    Children with impaired renal function

    Dose adjustment is based on the maximum recommended dose of amoxicillin.

    Creatinine clearance> 30 ml / min

    Correction of dose is not required

    Creatinine clearance 10-30 ml / min

    (25 mg / 5 mg) / kg 2 times a day.

    Creatinine clearance <10 ml / min

    (25 mg / 5 mg) / kg every 24 hours.

    Children on hemodialysis

    Correction of the dose is based on the maximum recommended content of amoxicillin. (25 mg / 5 mg) / kg every 24 hours and additionally (12.5 mg / 2.5 mg / kg at the end of the hemodialysis session (to compensate for the reduction in amoxicillin and clavulanic acid in the serum) and further (25 mg / 5 mg) / kg per day.

    Children with impaired liver function

    Treat with caution; regularly monitor liver function.

    Mode of application

    Bolus injection

    The powder is diluted with water for injection.

    Proportion / solvent ratio

    Bottle

    Solvent (ml)

    1000 mg / 200 mg

    20

    The drug can be administered as a slow intravenous injection lasting 3-4 minutes directly into the vein orthrough the catheter.

    The resulting solution must be introduced within 20 minutes after breeding.

    Infusion introduction:

    The drug is administered intravenously drip for 30-40 minutes, previously dissolving the powder in the volume of water for injection indicated in the table above, the resulting solution is added to 100 ml of the solvent: 0.9% sodium chloride solution, sodium lactate solution for intravenous administration, Ringer's solution, solution Ringer's lactate for Hartman.

    Side effects:

    From the digestive system: diarrhea, nausea, vomiting, dyspeptic disorders, colitis (including pseudomembranous and hemorrhagic).

    From the liver and bile ducts: moderate increase aspartate aminotransferase (ACT) and alanine aminotransferase (ALT), hepatitis, cholestatic jaundice, increased activity of alkaline phosphatase and / or bilirubin levels.

    From the side of the kidneys and urinary tract: interstitial nephritis, crystalluria, hematuria.

    From the nervous system: dizziness, headache, convulsions (can occur in patients with impaired renal function with high doses), insomnia, agitation, anxiety, behavioral changes, reversible hyperactivity.

    From the hematopoietic and lymphatic system: reversible leukopenia (including neutropenia), thrombocytopenia, reversible agranulocytosis and hemolytic anemia, prolongation of prothrombin time and bleeding time, eosinophilia, thrombocytosis, anemia.

    Superinfection: Candidiasis of the skin and mucous membranes.

    Local reactions: Phlebitis in place in / in the introduction.

    Allergic reactions: skin rash, itching, urticaria, multiforme exudative erythema, angioedema, anaphylactic reactions, whey-like syndrome, allergic vasculitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous exfoliative dermatitis, acute generalized exanthematous pustulosis.

    Overdose:

    Symptoms: disorders of the gastrointestinal tract and disturbance of the water electrolyte balance. Crystalluria, caused by the use of amoxicillin-containing drugs, in some cases led to renal failure.

    Treatment: symptomatic. Amoxicillin and clavulanic acid are removed from the blood by hemodialysis.

    In the presence of high concentrations of amoxicillin in urine, it can precipitate in urinary catheters at room temperature. It is necessary to regularly check the patency of such catheters.

    Interaction:

    Bactericidal antibiotics (including aminoglycosides, cephalosporins, vancomycin, rifampicin) have a synergistic effect; bacteriostatic medicinal products (macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) - antagonistic.

    Increases the effectiveness of indirect anticoagulants (suppressing the intestinal microflora, reduces the synthesis of vitamin K and prothrombin index). With the simultaneous use of indirect anticoagulants, it is necessary to monitor the clotting factor both during treatment and when the drug is withdrawn.

    Reduces the effectiveness of oral contraceptives, medicines (which should be warned by patients using oral hormonal contraceptives as a method of contraception), in the process of metabolism of which Paraaminobenzoic acid is formed, ethinyl estradiol - risk of bleeding "breakthrough".

    Diuretics, allopurinol, phenylbutazone, non-steroidal anti-inflammatory drugs and other drugs that block tubular secretion, increase the concentration of amoxicillin.

    Allopurinol increases the risk of skin rash.

    When combined with methotrexate, the toxicity of methotrexate is increased. Probenecid reduces the excretion of amoxicillin, increasing its serum concentration.

    In patients who received mycophenolate mofetil, after the start of the combination of amoxicillin with clavulanic acid, a decrease in the concentration of the active metabolite, mycophenolic acid, was observed before taking the next dose of the drug by approximately 50%. Changes in this concentration can not accurately reflect the overall changes in the exposure of mycophenolic acid.

    The use of the drug leads to a high content of amoxicillin in the urine, which can lead to false-positive results in the determination of glucose in the urine (for example, the Benedict test, Feeling's test). In this case, it is recommended to use a glucose oxidase method to determine the concentration of glucose in the urine.

    Pharmaceutical incompatibility

    Pharmaceutically incompatible with solutions containing blood, proteins, lipids, glucose, dextran, bicarbonate. When used simultaneously with aminoglycosides, antibiotics should not be mixed in a single syringe and in a vial for intravenous fluids,since aminoglycosides lose activity under such conditions.

    Do not mix in a syringe or infusion bottle with other medications.

    Special instructions:

    At course treatment it is necessary to monitor the status of the function of the organs of hematopoiesis, liver and kidneys.

    With the appointment of patients with sepsis, the development of a bacteriolysis reaction (the Yarisch-Gerxheimer reaction) is possible.

    Before starting treatment with the drug, you need to collect a detailed history of previous hypersensitivity reactions to penicillins, cephalosporins or other allergens. In patients who are hypersensitive to penicillins, there may be cross-allergic reactions with cephalosporin antibiotics. If parenteral administration of large doses of the drug is necessary for patients on a diet with a low salt content, the presence of sodium in the preparation should be taken into account.

    Amoxicillin and clavulanic acid may provoke non-specific binding of immunoglobulins and albumins to the erythrocyte membrane, which may be the cause of a false positive Coombs test.

    It is necessary to refrain from using the drug in case of suspected infectious mononucleosis, since in patients with such a disease amoxicillin can cause a skinlike skin rash that makes diagnosis difficult.

    The drug should be used with caution in patients with impaired liver function, with periodic monitoring of liver function.

    In patients with impaired renal function, the dose of the drug should be reduced, respectively, the degree of impairment (see section "Method of administration and dose").

    When severe and persistent diarrhea occurs, it is necessary to remember the possibility of developing pseudomembranous colitis. In this case, the drug is canceled and prescribed necessary treatment. The use of drugs that inhibit intestinal peristalsis is contraindicated in these cases.

    In patients with reduced diuresis, very rarely crystalluria occurs, mainly with parenteral administration of the combination amoxicillin + clavulanic acid. When large doses of amoxicillin are administered, it is recommended to take a sufficient amount of fluid and maintain adequate diuresis to reduce the likelihood of amoxicillin crystals.

    In the treatment with the drug, the development of superinfection (usually caused by bacteria of the genus Pseudomonas or fungi of the genus Candida). In this case, discontinue drug therapy and / or prescribe appropriate treatment.

    Effect on the ability to drive transp. cf. and fur:

    In the event of adverse reactions from the nervous system, patients are advised to refrain from driving and other mechanisms that require a high concentration of attention and speed of psychomotor reactions.

    Form release / dosage:

    Powder for the preparation of a solution for intravenous administration of 1000 mg + 200 mg.

    Packaging:

    1000 mg in terms of amoxicillin + 200 mg in terms of clavulanic acid in a bottle of colorless transparent glass (hydrolytic class I), sealed with a rubber stopper and an aluminum cap with a protective plastic cover on which the logo is marked "Elfa".

    1 bottle is placed in a cardboard box together with instructions for use.

    Or 50 bottles are placed in a cardboard box together with instructions for use (for hospitals).
    Storage conditions:

    Store in a dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-002490
    Date of registration:05.06.2014 / 04.07.2016
    Expiration Date:05.06.2019
    The owner of the registration certificate:ELFA NPC, CJSC ELFA NPC, CJSC Russia
    Manufacturer: & nbsp
    Information update date: & nbsp18.08.2017
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