Amoxicillin + Clavulanic acid - instructions for use, dose, side effects, contraindications

Has bactericidal action due to inhibition of bacterial cell wall synthesis. Violates the synthesis of peptidoglycan - a biopolymer, the main component of the bacterial cell wall. It inhibits the peptidoglycan transpeptidase, inhibits the activity of the endogenous inhibitor, which leads to activation of murein hydrolase, which cleaves peptidoglycan. Effective against fissile bacteria, in the walls of which the synthesis of peptidoglycan occurs.

Semisynthetic antibiotic with a broad spectrum of action from the group of penicillins. Disintegrates under the action of β-lactamases.

Has a bactericidal effect against gram-negative bacteria: Acinetobacter spp., Moraxella catarrhalis, Citrobacter spp. (including Citrobacter freundii, Citrobacter diversus, Citrobacter amalonaticus), Enterobacter spp., Escherichia coli, Haemophilus influenzae, Klebsiella spp. (including Klebsiella pneumoniae), Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Pseudomonas spp. (at including Pseudomonas aeruginosa, Pseudomonas maltophilia), Salmonella spp., Serratia spp. (including Serratia marcescens); gram-positive bacteria: Staphylococcus aureus, Staphylococcus epidermidis (coagulase-negative strains), Staphylococcus saprophyticus, Streptococcus agalactiae (group B), Streptococcus bovis, Enterococcus faecalis, Streptococcus pneumoniae, Streptococcus pyogenes (group A, beta-hemolytic), Streptococcus viridans; anaerobic bacteria: Bacteroides spp., including Bacteroides fragilis group (Bacteroides fragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicronron, Bacteroides ovatus, Bacteroides distasonis) and non-Bacteroides fragilis (beta-melanogenic), Clostridium spp. (including Clostridium perfringens, Clostridium difficile, Clostridium sporogenes, Clostridium ramosum, Clostridium bifermentans), Eubacterium spp., Fusobacterium spp. (including Fusobacterium nucleatum and Fusobacterium necrophorum), Peptococcus spp., Peptostreptococcus spp., Veillonella spp.

Clavulanic acid

It has no clinically significant effect, but, having a β-lactam structure associated with penicillins, competitively inhibits β-lactamase, preventing the inactivation of amoxicillin and expanding its spectrum of activity.

Pharmacokinetics:

Amoxicillin

After intravenous administration, the maximum concentration in the blood plasma is reached after 30 minutes. After oral administration, up to 80% is absorbed in the gastrointestinal tract. The connection with plasma proteins is 50%.

Therapeutic effect develops after the reception. Metabolism in the liver.

The elimination half-life is 78 minutes. Elimination by the kidneys.

Clavulanic acid

After intravenous administration, the maximum concentration in the blood plasma is reached after 1 hour. The connection with plasma proteins is 25%. It penetrates the placental barrier and enters the breast milk.

Metabolism in the liver.

The elimination half-life is 64 minutes. Elimination by the kidneys.

The drug is removed during hemodialysis.

Indications:

It is used to treat infectious diseases caused by pathogens sensitive to the drug: bone and connective tissue, skin and subcutaneous tissue, lower respiratory tract, septicemia, peritonitis, urinary tract infections.

ICD-10

I.A30-A49.A40 Streptococcal septicemia

I.A30-A49.A41 Other septicemia

X.J10-J18.J15 Bacterial pneumonia, not elsewhere classified

X.J20-J22.J20 Acute bronchitis

X.J20-J22.J21.9 Acute bronchiolitis, unspecified

XI.K65-K67.K65.0 Acute peritonitis

XI.K80-K87.K81.0 Acute cholecystitis

XI.K80-K87.K81.1 Chronic cholecystitis

XI.K80-K87.K83.0 Cholangitis

XII.L00-L08.L01 Impetigo

XII.L00-L08.L02 Abscess of skin, boil and carbuncle

XII.L00-L08.L03 Phlegmon

XII.L00-L08.L08.0 Pyoderma

XIII.M00-M03.M00 Pyogenic arthritis

XIII.M86-M90.M86 Osteomyelitis

XIV.N10-N16.N11 Chronic tubulointerstitial nephritis

XIV.N10-N16.N10 Acute tubulointerstitial nephritis

XIV.N10-N16.N15.1 Abscess of kidney and adrenal tissue

XIV.N30-N39.N30 Cystitis

XIV.N30-N39.N34 Urethritis and urethral syndrome

XIV.N40-N51.N41 Inflammatory diseases of the prostate

XIV.N70-N77.N70 Salpingitis and oophoritis

XIV.N70-N77.N71.0 Acute inflammatory disease of the uterus

XIV.N70-N77.N72 Inflammatory disease of the cervix

XIV.N70-N77.N73.0 Acute parametritis and pelvic cellulite

XIX.T79.T79.3 Post-traumatic wound infection, not elsewhere classified

XXI.Z20-Z29.Z29.2 Another type of preventive chemotherapy

Contraindications:

Individual intolerance to β-lactam antibiotics: penicillins and cephalosporins.

Carefully:

Pregnancy, imbalance of electrolytes or fluids, severe liver damage.

Pregnancy and lactation:

Recommendations for FDA - Category B. It is used in pregnancy and lactation.

Dosing and Administration:

Use in children

Newborns and children up to 3 months: 15 mg every 12 hours.

Children weighing less than 40 kg: 30 mg / kg every 12 hours, with severe infections - 40 mg / kg every 8 hours.

For parenteral administration:

Newborns and prematurity - 30 mg / kg every 12 hours.

From 3 months to 12 years with a body weight of less than 40 kg - 30 mg / kg every 8 hours.

The highest daily dose: for amoxicillin - 45 mg / kg; for clavulanic acid - 10 mg / kg.

Adults and children over 12 years of age

Inside, 375 mg every 8 hours or 625 mg 2-3 times a day.

Intravenously drip for 30 minutes.

Adults and children with a body weight above 40 kg: 1.2 g every 6-8 hours.

The highest daily dose: for amoxicillin - 6 g; for clavulanic acid - 600 mg.

Side effects:

Central and peripheral nervous system: rarely - convulsions.

Hemopoietic system: thrombocytopenia, eosinophilia, leukopenia, an increase in prothrombin index and coagulation time.

Digestive system: nausea, vomiting, diarrhea, increased activity of hepatic enzymes, hepatic or cholestatic jaundice, intestinal dysbacteriosis.

Dermatological reactions: local reactions - compaction at the injection site, candidiasis dermatitis, vulvovaginitis.

urinary system: rarely - the development of hypokalemia.

Allergic reactions.

Overdose:

Nausea, vomiting, diarrhea, neuromuscular excitability, convulsive attacks.

Treatment is symptomatic, hemodialysis.

Interaction:

Simultaneous application with probenecid slows the renal excretion of amoxicillin.

The drug is pharmacologically incompatible with other agents when administered parenterally one solution.

Special instructions:

Clavulanic acid can cause non-specific binding of albumin and immunoglobulin to erythrocyte membranes, which leads to false-positive results of Coombs reaction.

Instructions

Amoxicillin + Clavulanic acid (Amoxycillinum + Acidum clavulanicum)