Orally Administered Amoxicillin/Clavulanate: Current Role in Outpatient Therapy
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COMMENTARY
Orally Administered Amoxicillin/Clavulanate: Current Role in Outpatient Therapy Balaji Veeraraghavan . Yamuna Devi Bakthavatchalam . Rani Diana Sahni
Received: September 22, 2020 / Accepted: November 19, 2020 Ó The Author(s) 2020
ABSTRACT Oral amoxicillin/clavulanate is a community workhorse antibiotic, routinely prescribed for respiratory tract infections, skin infections as well as urinary tract infections (UTIs). Multiple adult and paediatric dose formulations of amoxicillin/clavulanate are available in different parts of the world. In adult formulations, clavulanic acid dose is restricted to 125 mg because of tolerability issues. Despite its popular use for 40 years, few pharmacokinetic/pharmacodynamic (PK/PD) studies were undertaken to justify the doses and breakpoints currently in use for various infections. Clavulanate has a minimal role in the combination’s use for respiratory infections. In the context of rising extended spectrum beta-lactamase (ESBL) prevalence globally, empirical and overuse of
B. Veeraraghavan (&) Y. D. Bakthavatchalam R. D. Sahni Department of Clinical Microbiology, Christian Medical College, Vellore, India e-mail: [email protected]
orally administered amoxicillin/clavulanate may select resistance in Gram-negative pathogens. The susceptibility test methods and interpretive criteria differ between the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Third-generation oral cephalosporins such as ceftibuten or cefpodoxime can be combined with amoxicillin/clavulanate to tackle UTIs involving ESBL producing Escherichia coli and Klebsiella spp. Clinicians who routinely prescribe amoxicillin/clavulanate in outpatient settings should be aware of potential benefits and limitations of this combination.
Keywords: Amoxicillin/clavulanate; Outpatient; Pneumonia; UTI
Infect Dis Ther
Key Summary Points Various dosing regimens of amoxicillin/clavulanate such as 250/125 mg q8h, 500/125 or 750/125 or 1000/125 mg are available for the management of infections. However, few PK/PD studies were undertaken to justify its doses and breakpoints. Oral amoxicillin/clavulanate is often prescribed for community respiratory tract infections as well as urinary tract infections (UTIs). In the context of rising ESBL prevalence globally, empirical use of orally administered amoxicillin/clavulanate in UTI is questionable. Third-generation oral cephalosporins such as ceftibuten or cefpodoxime can be combined with amoxicillin/clavulanate to tackle UTIs involving ESBL producing Escherichia coli and Klebsiella spp.
DIGITAL FEATURES This article is published with digital features, including a summary slide, to facilitate understanding of the article. To view digital features for this article go to https://doi.org/10.6084/ m9.figshare.13259639
INTRODUCTION Until 1960, the entire b-lactam family comprised only two narrow spectrum, Gram-positive bacteria-active antibiotics—penicillin G and penicillin V. Beecham Research La
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