AMOXICILLIN/CLAVULANIC ACID = CO-AMOXICLAV injectable

Prescription under medical supervision


Therapeutic action

– Penicillin antibacterial, combined with a beta-lactamase inhibitor. 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

– Erysipelas and cellulitis
– Necrotizing infections of the skin and soft tissues (necrotizing fasciitis, gas gangrene, etc.), in combination with clindamycin
– Severe postpartum upper genital tract infection, in combination with gentamicin

Forms and strengths, route of administration

– Powder for injection, in vials containing 1 g amoxicillin/100 mg clavulanic acid and 1 g amoxicillin/200 mg clavulanic acid, to be dissolved in 20 ml water for injection or 0.9% sodium chloride, for slow IV injection (3 minutes) or IV infusion (30 minutes). DO NOT DILUTE IN GLUCOSE.

Dosage

Doses expressed in amoxicillin:

Erysipelas, cellulitis
Child under 3 months: 30 mg/kg every 12 hours 
Child 3 months and over: 20 to 30 mg/kg every 8 hours (max. 3 g daily)
Adult: 1 g every 8 hours

Necrotizing infections
Child under 3 months: 50 mg/kg every 12 hours
Child 3 months and over and < 40 kg: 50 mg/kg every 8 hours (max. 6 g daily)
Child 40 kg and over and adult: 2 g every 8 hours 

Upper genital tract infection
Adult: 1 g every 8 hours

For administration by IV infusion, dilute each dose of amoxicillin/clavulanic acid in 5 ml/kg of 0.9% sodium chloride in children less than 20 kg and in a bag of 100 ml of 0.9% sodium chloride in children 20 kg and over and in adults.

Duration

Erysipelas, cellulitis: 7 to 10 days; necrotizing infections: 14 days; upper genital tract infection: depending on clinical response. Change to oral treatment as soon as possible.

Contra-indications, adverse effects, precautions

– Do not administer to penicillin-allergic patients, patients with history of hepatic disorders during a previous treatment with co-amoxiclav, patients with infectious mononucleosis.
– Administer with caution to patients allergic to cephalosporins (cross-sensitivity may occur), patients with hepatic impairment or severe renal impairment (reduce dosage and give every 12 to 24 hours).
– May cause: diarrhoea; hepatic disorders (avoid treatments longer than 14 days); allergic reactions sometimes severe.
– Do not combine with methotrexate (increased methotrexate toxicity).
Pregnancy: no contra-indication
Breast-feeding: no contra-indication

Remarks

– Preferably use 1 g amoxicillin/100 mg clavulanic acid, especially in children.
– Do not mix with other drugs in the same syringe or infusion bag.
Storage: below 25 °C
Once reconstituted, the solution must be used immediately; discard any unused open vial.