AMOXICILLIN/CLAVULANIC acid = CO-AMOXICLAV oral

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    Prescription under medical supervision

     

     

    Therapeutic action

    • Combination of two antibacterials. The addition of clavulanic acid to amoxicillin extends its spectrum of activity to cover beta-lactamase producing Gram-positive and Gram-negative organisms, including some Gram-negative anaerobes.

    Indications

    • Animal bites, if antibiotic therapy or antibiotic prophylaxis is clearly indicated
    • Second line treatment of acute otitis media and acute bacterial sinusitis, when amoxicillin alone given at high dose failed
    • Acute uncomplicated cystitis (no systemic signs) in girls over 2 years
    • Postpartum upper genital tract infection
    • Parenteral to oral switch therapy in severe infections (e.g. severe pneumonia)

    Forms and strengths

    • The ratio of amoxicillin and clavulanic acid varies according to the manufacturer:

     

    Ratio 8:1

    • 500 mg amoxicillin/62.5 mg clavulanic acid tablet
    • 500 mg amoxicillin/62.5 mg clavulanic acid/5 ml powder for oral suspension

    Ratio 7:1

    • 875 mg amoxicillin/125 mg clavulanic acid tablet
    • 400 mg amoxicillin/57 mg clavulanic acid/5 ml, powder for oral suspension
    • 200 mg amoxicillin/28.5 mg clavulanic acid dispersible tablet

     

    Dosage

    (expressed in amoxicillin)


    Animal bites; second line treatment of acute otitis media and acute sinusitis

    • Child < 40 kg: 25 mg/kg 2 times daily
    • Child ≥ 40 kg and adult:
      • Ratio 8:1: 2000 mg daily = 2 tablets of 500/62.5 mg 2 times daily
      • Ratio 7:1: 1750 mg daily = 1 tablet of 875/125 mg 2 times daily

     

    Acute uncomplicated cystitis in girls > 2 years

    • 12.5 mg/kg 2 times daily

     

    Postpartum upper genital tract infection; parenteral to oral switch therapy in severe infections

    • Child < 40 kg: 50 mg/kg 2 times daily
    • Child ≥ 40 kg and adult:
      • Ratio 8:1: 3000 mg daily = 2 tablets of 500/62.5 mg 3 times daily
      • Ratio 7:1: 2625 mg daily = 1 tablet of 875/125 mg 3 times daily

    Duration

    • Animal bites: 5 to 7 days
    • Otitis media: 5 days
    • Sinusitis: 7 to 10 days
    • Cystitis: 3 days
    • Upper genital tract infection: 7 days
    • Parenteral to oral switch therapy in severe pneumonia: to complete a total of 10 to 14 days of treatment.

    Contra-indications, adverse effects, precautions

    • Do not administer to penicillin-allergic patients and patients with history of hepatic disorders during a previous treatment with co-amoxiclav.
    • Administer with caution to patients allergic to cephalosporins (cross-sensitivity may occur).
    • Administer with caution to patients with hepatic impairment; reduce dosage and give every 12 to 24 hours in patients with severe renal impairment.
    • May cause: gastrointestinal disturbances (mainly diarrhoea); allergic reactions sometimes severe (stop treatment immediately); jaundice and cholestatic hepatitis in the event of prolonged treatment (> 10 to 15 days).
    • The dose of clavulanic acid should not exceed 12.5 mg/kg daily or 375 mg daily.
    • Pregnancy: no contra-indication
    • Breast-feeding: no contra-indication

    Remarks

    • Take with meals.
    • Also comes in formulations with a ratio of amoxicillin/clavulanic acid of 4:1: 125 mg amoxicillin/31.25 mg clavulanic acid/5 ml powder for oral suspension and 500 mg amoxicillin/125 mg clavulanic acid tablet. The maximum dose (expressed in amoxicillin) that can be given with these formulations is 50 mg/kg daily, without exceeding 1500 mg daily.

    Storage

     
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    Below 25 °C