Amoxicillin/clavulanic acid, also known as co-amoxiclav or amox-clav, sold under the brand name Augmentin, among others, is an
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
medication used for the treatment of a number of
bacterial infections.
[ It is a combination consisting of amoxicillin, a β-lactam antibiotic, and ]potassium clavulanate
Clavulanic acid is a β-lactam drug that functions as a mechanism-based β-lactamase inhibitor. While not effective by itself as an antibiotic, when combined with penicillin-group antibiotics, it can overcome antibiotic resistance in bacteri ...
, a β-lactamase inhibitor
Beta-lactamases, (β-lactamases) are enzymes () produced by bacteria that provide multi-resistance to beta-lactam antibiotics such as penicillins, cephalosporins, cephamycins, monobactams and carbapenems (ertapenem), although carbapenems ...
.[ It is specifically used for ]otitis media
Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...
, streptococcal pharyngitis
Streptococcal pharyngitis, also known as streptococcal sore throat (strep throat), is pharyngitis (an infection of the pharynx, the back of the throat) caused by ''Streptococcus pyogenes'' a gram-positive, group A streptococcus. Common symptom ...
, pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
, cellulitis, urinary tract infections, and animal bites
An animal bite is a wound, usually a puncture or laceration, caused by the teeth. An animal bite usually results in a break in the skin but also includes contusions from the excessive pressure on body tissue from the bite. The contusions can occ ...
.[ It is taken by mouth or by ]injection into a vein
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
.side effects
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...
include diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
, vomiting, and allergic reactions.[ It also increases the risk of ]yeast infections
Candidiasis is a fungal infection due to any type of '' Candida'' (a type of yeast). When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth ...
, headaches, and blood clotting problems
Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding (bleeding diathesis), which may occur spo ...
.[ It is not recommended in people with a history of a penicillin allergy.][ It is relatively safe for use during pregnancy.][
Amoxicillin/clavulanic acid was approved for medical use in the United States in 1984.][ In 2020, it was the 107th most commonly prescribed medication in the United States, with more than 6million prescriptions.
]
Medical uses
Amoxicillin/clavulanic acid is widely used to treat or prevent many infections caused by susceptible bacteria, such as:
*urinary tract infection
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
s
*respiratory tract infection
Respiratory tract infections (RTIs) are infectious diseases involving the respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection (URI or URTI) or a lower respiratory tract infection (LRI ...
s
*skin and soft tissue infections
*sinus infections
*tonsillitis
Tonsillitis is inflammation of the tonsils in the upper part of the throat. It can be acute or chronic. Acute tonsillitis typically has a rapid onset. Symptoms may include sore throat, fever, enlargement of the tonsils, trouble swallowing, and en ...
*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)tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
that is resistant to other treatments.[ The World Health Organisation recommends giving amoxicillin-clavulanate along with meropenem as one of the therapeutic options in drug resistant tuberculosis, where clavulanate and not amoxicillin is being relied upon for anti TB activity. 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 treatment regime for drug resistant TB and this has been demonstrated in a clinical setting also.
This combination results in an antibiotic with an increased spectrum of action and restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.
]
Adverse effects
Possible side effects include diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
, vomiting, nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...
, thrush
''The Man from U.N.C.L.E.'' is an American spy fiction television series produced by Metro-Goldwyn-Mayer Television and first broadcast on NBC. The series follows secret agents, played by Robert Vaughn and David McCallum, who work for a secret ...
, and skin rash
A rash is a change of the human skin which affects its color, appearance, or texture.
A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cr ...
. These do not usually require medical attention. As with all antimicrobial agents, antibiotic-associated diarrhea due to ''Clostridium difficile
''Clostridioides difficile'' (syn. ''Clostridium difficile'') is a bacterium that is well known for causing serious diarrheal infections, and may also cause colon cancer. Also known as ''C. difficile'', or ''C. diff'' (), is Gram-positive spec ...
'' infection—sometimes leading to pseudomembranous colitis
Colitis is swelling or inflammation of the large intestine ( colon). Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.
In a medical context, the label ''colitis'' (without qualification) ...
—may occur during or after treatment with amoxicillin/clavulanic acid.cholestatic jaundice
Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metab ...
(also referred to as cholestatic hepatitis, a form of liver toxicity
Hepatotoxicity (from ''hepatic toxicity'') implies chemical-driven liver damage. Drug-induced liver injury is a cause of acute and chronic liver disease caused specifically by medications and the most common reason for a drug to be withdrawn fro ...
) has been associated with amoxicillin/clavulanic acid. The reaction may occur up to several weeks after treatment has stopped, and usually takes weeks to resolve. It is more frequent in men, older people, and those who have taken long courses of treatment; the estimated overall incidence is one in 100,000 exposures.aminopenicillin
The aminopenicillins are a group of antibiotics in the penicillin family that are structural analogs of ampicillin (which is the 2-amino derivative of benzylpenicillin, hence the name). Like other penicillins and beta-lactam antibiotics, they co ...
s, amoxicillin has been associated with Stevens–Johnson syndrome/ toxic epidermal necrolysis, although these reactions are very rare.
History
British scientists working at Beecham Beecham is a surname. Notable people with the surname include:
* Audrey Beecham (1915–1989), poet and niece of the conductor
* Betty Humby Beecham (1908–1958), British pianist and wife of the conductor
* Earl Beecham (born 1965), American foo ...
(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
A British Approved Name (BAN) is the official, non-proprietary, or generic name given to a pharmaceutical substance, as defined in the British Pharmacopoeia (BP). The BAN is also the official name used in some countries around the world, because ...
(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
Clavulanic acid is a β-lactam drug that functions as a mechanism-based β-lactamase inhibitor. While not effective by itself as an antibiotic, when combined with penicillin-group antibiotics, it can overcome antibiotic resistance in bacteria t ...
.parenteral
A route of administration in pharmacology and toxicology is the way by which a drug, fluid, poison, or other substance is taken into the body.
Routes of administration are generally classified by the location at which the substance is applied. ...
preparation is available in the US; the nearest equivalent is ampicillin/sulbactam.
Suspensions
In chemistry, a suspension is a heterogeneous mixture of a fluid that contains solid particles sufficiently large for sedimentation. The particles may be visible to the naked eye, usually must be larger than one micrometer, and will eventually ...
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: periodontitis
Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main caus ...
, kennel cough
Kennel cough, also known as canine infectious respiratory disease, formally canine infectious tracheobronchitis, is an upper respiratory infection affecting dogs. There are multiple causative agents, the most common being the bacterium ''Bordete ...
* Cats: urinary tract infections, skin and soft tissue infections
* Calves: enteritis, navel ill
* Cattle: respiratory tract infections, soft tissue infections, metritis, mastitis
* Pigs: respiratory tract infections, colibacillosis
''Escherichia coli'' ( Anglicized to ; commonly abbreviated ''E. coli'') is a gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms (endotherms). Most ''E. coli'' strains are harmless, but ...
, mastitis, metritis, agalactia
In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nu ...
In combination with prednisolone
Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthrit ...
, it is used for intramammary infusion for the treatment of mastitis in lactating
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The proces ...
cows. Trade names include Clavaseptin, Clavamox, and Synulox.
Amoxicillin/clavulanic acid is banned from use in domestic-food animals (cattle, swine, etc.) in both the US and Europe; in the UK, Synulox can be used in domestic-food animals as long as a specified withdrawal period is observed.
Bacterial resistance
Bacterial antibiotic resistance
Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. ...
is a growing problem in veterinary medicine
Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...
. Amoxicillin/clavulanic acid is reported to be effective against clinical ''Klebsiella
''Klebsiella'' is a genus of Gram-negative, oxidase-negative, rod-shaped bacteria with a prominent polysaccharide-based capsule.
''Klebsiella'' species are found everywhere in nature. This is thought to be due to distinct sublineages developin ...
'' infections, but is not efficacious against '' Pseudomonas'' infections.[Federation of Veterinarians in Europe Position Paper: "Antibiotic Resistance & Prudent Use of Antibiotics in Veterinary Medicine"]
References
External links
*
{{DEFAULTSORT:Amoxicillin Clavulanic Acid
Combination antibiotics
Hepatotoxins
GSK plc brands
Penicillins
World Health Organization essential medicines
Wikipedia medicine articles ready to translate