AMOXICILLIN-CLAVULANATE

Antibacterial Activity

Effective against most gram-positive including enteroccoci
Effective against most gram-negative (eg. H. influenza, M. catarrhalis)
Effective against  anaerobes
Effective against  b-lactamase producing organisms

Pregnancy Risk Factor

Category B

Contraindication/Precaution

Hypersensitivity to amoxicillin or clavulanate or any penicillins or any component
Do not use if AM/CL associated liver dysfunction, cholestatic jaundice or PKU
Do not use if concomitant use of disulfiram
Use caution with patient who are allergic to cephalosporins, they could have an hypersensibility to penicillins
Use caution if EBV, CMV or LLA: may develop rash
Use caution if impaired renal/liver function

Mechanism of Action

Selective inhibitors of bacterial cell wall synthesis, by binding to penicillins binding proteins (PBP'S)
Clavulanate inhibits b-lactamase

Pharmacodynamics/Kinetics

Metabolism: 
Liver (partially)
Half-life: 
both: 1 hour, change with renal function.
Elimination: 
both: excreted  in urine

Dosage

Children: (max 2 g/day (amox))

Body weight > 2000 g
> 28 days old: 30-50 mg/kg/d (amox) PO div tid

Adults: ( and children >40kg)

250-500 mg (amox) PO q8h

Dosage In Renal Failure

Creatinine clearance (ml/min):
<10: same dose but q24h 10-50: same dose but q8-12h 50-80: unchanged >80: unchanged
Dialysis
Hemo: post dialysis dose=250 mg (amox) PO
CAPD: 250 mg (amox) PO q12h