Amoxicillin/clavulanic acid

Amoxicillin/clavulanic acid is widely used to treat or prevent many infections caused by susceptible bacteria, such as: • Urinary tract infections • Respiratory tract infections • Skin and soft tissue infections • Sinus infections • Tonsillitis • Cat scratches • Infections caused by the bacterial flora of the mouth, such as: • Dental infections • Infected animal bites • Infected human bites (including uncomplicated "clenched-fist" or "reverse-bite" injuries) • Treatment-resistant tuberculosis (see below) • Diverticulitis Urinary tract infections Amoxicillin/clavulanic acid is a second-line therapy in the treatment of uncomplicated urinary tract infections (UTIs). It is active against UTIs caused by Staphylococcus saprophyticus, Enterococci (e.g., Enterococcus faecalis), Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. A 2012 network meta-analysis of antibiotics for uncomplicated UTIs found that it was less effective than all other assessed agents, including trimethoprim/sulfamethoxazole, nitrofurantoin, fosfomycin, fluoroquinolones (ciprofloxacin, norfloxacin, and gatifloxacin), and pivmecillinam. However, across the spectrum of dosage of amoxicillin-clavulanate combination, the dose of clavulanate is constant at 125 mg, whereas the dose of amoxicillin varies at 250 mg, 500 mg and 875 mg. Thus the use of low-dose amoxicillin-clavulanate in combination with meropenem may be used in part of a treatment regimen for drug-resistant TB and this has been demonstrated in a clinical setting also. Its efficacy is attributed not to the amoxicillin component, but to the protective action of clavulanic acid over meropenem against beta-lactamase produced by the mycobacteria. Therefore, the minimum dosage of amoxicillin (250 mg) is recommended. ==Adverse effects==

Possible side effects include diarrhea, vomiting, nausea, thrush, and skin rash. These do not usually require medical attention. As with all antimicrobial agents, antibiotic-associated diarrhea due to Clostridioides difficile infection—sometimes leading to pseudomembranous colitis—may occur during or after treatment with amoxicillin/clavulanic acid. ==Pharmacology==

Amoxicillin is an antibiotic of the penicillin family, while clavulanic acid is a non-antibiotic β-lactamase inhibitor that prevents inactivation of penicillins by certain resistant bacteria. In addition to its β-lactamase inhibition, clavulanic acid shows central nervous system actions and effects and has been studied in the potential treatment of various psychiatric and neurological disorders. ==History==

British scientists working at Beecham (now part of GlaxoSmithKline) filed for patent protection for the drug combination in 1977, which was granted in 1982. It was sold under the brand name Augmentin. ==Preparations==

Amoxicillin/clavulanic acid is the International Nonproprietary Name (INN) and co-amoxiclav is the British Approved Name (BAN). Many branded products indicate their strengths as the quantity of amoxicillin. Augmentin 250, for example, contains 250 mg of amoxicillin and 125 mg of clavulanic acid. An intravenous preparation has been available in the UK since 1985, but no parenteral preparation is available in the US; the nearest equivalent is ampicillin/sulbactam. Suspensions of amoxicillin/clavulanic acid are available for use in children. They must be refrigerated to maintain effectiveness. ==Veterinary use==

Amoxicillin/clavulanic acid is used in numerous animals for a variety of conditions: • Dogs: Skin and soft tissue infections such as wounds, abscesses, cellulitis, superficial/juvenile and deep pyoderma due to susceptible strains of the following organisms: β-lactamase-producing Staphylococcus aureus, non-β-lactamase-producing Staphylococcus aureus, Staphylococcus spp., Streptococcus spp., and E. coli; and periodontal infections due to susceptible strains of both aerobic and anaerobic bacteria. • Cats: Skin and soft tissue infections such as wounds, abscesses, and cellulitis/dermatitis due to susceptible strains of the following organisms: β-lactamase-producing Staphylococcus aureus, non-β-lactamase-producing Staphylococcus aureus, Staphylococcus spp., Streptococcus spp., E. coli, and Pasteurella spp; urinary tract infections (cystitis) due to susceptible strains of E. coli. ==References==