Amoksiklav – an antibiotic with versatile action. When should it be used?

Proven content

Amoksiklav is a prescription antibiotic. It is used in cases of bacterial infections, most often in the treatment of infections of the respiratory tract, ear, sinuses, urinary tract, skin, tissues, bones and joints. How does Co-amoxiclav work and how should it be dosed? Are there any contraindications to the use of this antibiotic? How much does Amoksiklav cost after refund and are there substitutes available on the market?

It is worth mentioning, however, that it is available in various forms:

1. granules for oral suspension 875 mg + 125 mg – 14 sachets in the package;
2. powder for oral suspension 400 mg + 57 mg / 5 ml – 35 ml or 70 ml or 140 ml bottle;
3. powder for solution for injection or infusion 500 mg + 100 mg – 5 vials per package;
4. powder for solution for injection or infusion 1000 mg + 200 mg – 5 vials per package;
5. coated tablets 250 mg + 125 mg – 21 pieces in a package;
6. coated tablets 500 mg + 125 mg – 14 or 21 pieces in a package;
7. 875 mg + 125 mg film-coated tablets – 14 or 20 pieces in the package.

The manufacturer of Amoksiklav is Sandoz GmbH, i.e. a world leader in the generic and biosimilar drugs market.

The concern, which is popular today, started its activity as a small chemical company. Its origins date back to 1886. The company was founded in Basel, Switzerland, and was involved in the production of dyes. Within 10 years, it was possible to develop and produce the first pharmaceutical substance, i.e. antipyrine. In 1929, Calcium Sandoz, a preparation that became a breakthrough drug in modern calcium therapy, was introduced to the market. To this day, it is one of the most recognizable preparations of the Sandoz GmbH concern.

What should you know about antibiotics? Check: Antibiotics – types, action, use and side effects [EXPLAIN]

Amoksiklav – composition and action of the drug

Co-amoxiclav is a combined antibiotic and contains two active substances, amoxicillin and clavulanic acid. The proportions of these two components are (usually) 7: 1 respectively.

The first of the active substances amoxicillin is a semi-synthetic penicillin that exhibits a fairly broad spectrum of antibacterial activity. This compound is classified as beta-lactam antibiotics, which indicates the presence of a characteristic beta-lactam ring in the molecule. The structure of this ring is influenced by enzymes from the group of beta-lactamases, which are produced by some bacteria.

1. Alexander Fleming – discoverer of penicillin. One of the hundred most important people of the XNUMXth century

Selected beta-lactazams that are present in bacterial cells affect the decomposition and inactivation of antibiotic molecules, which turns out to be one of the reasons for the resistance of given bacteria to the action of beta-lactam antibiotics. The action of beta-lactam antibiotics is to inhibit the synthesis of the bacterial cell wall, which in turn causes its weakening, and then the death of the bacterial cell.

The second active ingredient is clavulanic acidwhich inhibits the activity of selected beta-lactamases, i.e. enzymes that break down amoxicillin produced by resistant bacterial strains. The action of the acid makes resistant bacteria sensitive to the action of the antibiotic. It is worth mentioning that clavulanic acid itself does not show significant antibacterial activity.

Excipients of coated tablets are: colloidal anhydrous silica, crospovidone, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, hydroxypropyl cellulose, ethyl cellulose, polysorbate 80, triethyl citrate, titanium dioxide and talc.

Excipients of granules for oral suspension are: magnesium stearate, aspartame, lemon-peach-strawberry flavor, precipitated silica, sodium croscarmellose, as well as microcrystalline cellulose.

Excipients of the powder for oral suspension These are: citric acid anhydrous, sodium citrate anhydrous, microcrystalline cellulose, dried carboxymethyl cellulose, xanthan gum, colloidal anhydrous silica, silicon dioxide, wild cherry flavor, lemon flavor, dried sodium saccharin and mannitol.

In turn, in the composition tablets for oral suspension included: tropical fruit aroma, sweet orange aroma, aspartame, colloidal anhydrous silica, yellow iron oxide, talc, castor oil and microcrystalline silicified cellulose.

If you want to know more about amoxicillin read on: Amoxicillin

Amoksiklav – metabolism and excretion from the body

Both amoxicillin and clavulanic acid are very quickly absorbed from the gastrointestinal tract, so the maximum concentration occurs approximately one hour after taking the drug. The bioavailability of these two substances is approx. 70%.

The first component, i.e. amoxicillin, binds to plasma proteins in approx. 18%. On the other hand, clavulanic acid binds in approx. 25%. Both substances reach therapeutic concentrations in the gallbladder, abdominal organs, skin, adipose tissue, muscles, and in the synovial and peritoneal fluids.

Co-amoxiclav crosses the placenta and is excreted into breast milk, but not into the cerebrospinal fluid.

The metabolite of amoxicillin is inactive penicillinic acid which is mainly excreted by the kidneys. In turn, clavulanic acid is metabolized and excreted from the body in the urine and faeces and as carbon dioxide in the exhaled air.

Do you know who discovered penicillin? Check: Alexander Fleming – discoverer of penicillin. One of the hundred most important people of the XNUMXth century

1. cystitis;
2. pyelonephritis;
3. skin and soft tissue infections, especially cellulitis;
4. infections after animal bites;
5. infections of the reproductive organs in women;
6. severe periodontal abscess with spreading cellulitis; 
7. bone and joint infections, especially osteomyelitis;
8. as a preventive measure to help prevent infections during major surgery.

What false information is spreading about antibiotics? Read: Six myths about antibiotics

Have you taken an antibiotic? Don’t forget about probiotics that rebuild the bacterial flora. We also recommend a set of dietary supplements after antibiotic therapy that strengthen the body.

Amoksiklav – contraindications to use

Not every patient struggling with a bacterial infection can use Amoksiklav. In the package leaflet, the manufacturer included information on contraindications to the use of this antibiotic.

Contraindications to the use of Amoksiklav are:

1. hypersensitivity to the active substances or any other component of the drug;
2. hypersensitivity to any penicillins;
3. severe and immediate allergic reaction to this or that antibiotic in the past;
4. jaundice or been diagnosed with liver problems caused by the use of antibiotics in the past.

In the event of any contraindications to the use of an antibiotic, the doctor individually assesses the risk of using the drug in the patient.

What is anaphylactic shock and when can it occur? Read on: Anaphylactic Shock – Everything You Need to Know [EXPLAINED]

1. seizures may occur in patients with impaired renal function;
2. Amoksiklav should not be used in patients with suspected infectious mononucleosis;
3. long-term use of this antibiotic may cause excessive growth of microorganisms insensitive to its action;
4. erythema with pustules and fever may occur at the beginning of treatment, which is a consequence of acute pustular eruption. If such a reaction occurs, the drug should be discontinued;
5. in patients with impaired liver function, the drug should be used with great care;
6. in the case of long-term treatment, periodic assessment of the functions of internal organs, including kidneys, liver and the haematopoietic system, should be performed;
7. in patients with impaired renal function, the dose should be adjusted to the degree of renal failure;
8. in patients with an intravesical catheter, the patency of the catheter should be systematically monitored;
9. during treatment with amoxicillin, enzymatic glucooxidase methods for the determination of glucose in urine should be used, due to the possibility of false-positive results of non-enzymatic tests;
10. Positive test results in patients receiving amoxicillin / clavulanic acid should be interpreted with caution and confirmed by other diagnostic methods.

What is worth knowing about natural antibiotic therapy? Check: Natural antibiotics – you have them in your kitchen

1. 625 mg film-coated tablets and QUICKTAB 625 mg – in this variant, the proportion of amoxicillin and clavulanic acid is 4: 1. The drug in this form is intended for adults and children weighing more than 40 kilograms. The correct dose is one 625 mg tablet 3 times a day. Children weighing less than 40 kg can receive a dose of 20 to 60 mg of amoxicillin and, respectively, 5 to 15 mg of clavulanic acid per kilogram of body weight per day, divided into 3 doses. For patients under 6 years of age, the drug is recommended in the form of a suspension;
2. 1000 mg film-coated tablets and QUICKTAB 1000 mg, granules for suspension 1000 mg – in this variant, the ratio of amoxicillin and clavulanic acid is 7: 1. The drug is intended for adults and children weighing more than 40 kilograms. The dose is one tablet or 1 sachet of granules twice a day. If the infection is severe or acute, it is recommended to administer the drug three times a day. The suspension should be drunk with meals, and the tablets should be taken just before or at the beginning of a meal;
3. powder for suspension 457 mg / 5 ml – this is a variant of the drug that is recommended for children weighing no more than 40 kilograms. Amoxicillin and clavulanic acid are administered to the child in the amount of (25 mg + 3,6 mg) to (45 mg + 6,4 mg) / kg bw / day in 2 doses. In more severe infections, you can use up to (70 mg + 10 mg) of the substance for each kg of body weight per day in 2 divided doses. The suspension should be taken immediately before or at the beginning of a meal. The package includes a pipette for measuring and administering the dose;
4. powder for solution for injection or infusion – in this variant, the antibiotic is administered intravenously by a doctor or nurse. The drug is administered by intravenous injections or through a drip infusion tube. Adults and children weighing more than 40 kg are administered (1000 mg + 200 mg) of the drug, i.e. the contents of 2 vials every 8 hours. In the prophylaxis of infections in surgical procedures, the dose is (1000 mg + 200 mg) and it is administered simultaneously with anesthesia. 

What is worth remembering when using medications? Read: How to take medications effectively?

Amoksiklav – the effects of overdose

Taking too much Amoksiklav may lead to symptoms of drug overdose. An overdose of Amoksiklav may be manifested by:

1. nausea;
2. vomiting;
3. diarrhea;
4. convulsions.

How drugs can work on our body? Check: Adverse drug reactions

Amoksiklav – side effects

Taking the antibiotic Amoksiklav may cause side effects and side effects in patients. However, it is worth remembering that they do not occur in every patient, but any suspicious symptom should be immediately reported to a doctor.

Allergic reactions such as skin rash, inflammation of blood vessels, fever, joint pain, swollen lymph nodes, angioedema or fainting may occur after the use of Amoksiklav.

In every case after authorization of a medicinal product, it is important to report any suspected adverse reactions so that the benefit / risk balance of the medicinal product can be monitored.

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The general classification of the frequency of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare ( ≥100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

For Amoksiklav, the classification of side effects is as follows:

1. very common side effects (more than 1 in 10 people) – diarrhea;
2. common side effects (less than 1 in 10 people) – candidiasis, nausea, vomiting;
3. uncommon side effects (may affect up to 1 in 100 people) – rash, itching, hives, indigestion, dizziness, headache, increase in certain substances (enzymes) produced by the liver;
4. Rare side effects (may affect up to 1 in 1000 people) – skin rash with blisters, erythema multiforme, low number of white blood cells and cells involved in blood clotting shown in blood tests;
5. other side effects – allergic reactions, colitis, severe skin reactions, aseptic meningitis. 

How soon do antibiotics start working? Check: How long does the antibiotic work for?

Amoksiklav – interactions with other medications and alcohol

Before you start taking Co-amoxiclav, it is very important that you tell your doctor exactly what medicines you have used so far.

The antibiotic Amoksiklav must not be combined with:

1. allopurinol;
2. samplenecydem;
3. drugs that reduce blood clotting;
4. methotrexate;
5. mycophenolate mofetil. 

If the patient is taking anticoagulants, coagulation parameters should be monitored. It is not uncommon for the dose of the anticoagulant to be adjusted.

The active substance amoxicillin reduces the excretion of methotrexate, thus increasing its toxic effect on the body. In turn, probenecid reduces the tubular secretion of amoxicillin, increases its concentration in the blood and prolongs its action. The use of Co-amoxiclav with allopurinol may lead to skin rash.

Simultaneous administration of Amoksiklav and mycophenolate mofetil reduces the concentration of the active metabolite – mycophenolic acid. The patient should be observed both during treatment and after discontinuation of therapy.

What drugs should not be combined with each other? Check: Dangerous interactions

Amoksiklav and pregnancy and breastfeeding

Amoksiklav should not be used during pregnancy. The use of this preparation is allowed only when it is absolutely necessary, and the benefits of treatment outweigh the risk of harm to the fetus. However, it has not been seen that amoxycycline in combination with clavulanic acid increases the risk of birth defects in the child.

On the other hand, the use of Amoksilav should be carefully analyzed by a doctor in the case of breastfeeding women. It has been found that the active substances of the antibiotic pass into breast milk. If the mother uses the medicine, the baby may develop symptoms such as diarrhea, an allergic reaction or fungal colonization on the mucous membranes. Therefore, in most cases the decision to take Co-amoxiclav is associated with the weaning of the baby.

Can drugs be used during pregnancy? Check: Pregnancy and medications

Amoksiklav – price and refund

A very important information for patients whose doctor has prescribed the use of Amoksiklav is that this antibiotic is partially reimbursed. Drug prices may vary slightly, but on an average you should pay for the drug:

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1. Augmentin in coated tablets and powder for oral suspension;
2. Co-amoxiclav Bluefish in coated tablets;
3. Forcid in oral or suspension tablets;
4. Hiconcil Combi in coated tablets and powder for oral suspension;
5. Polamoclav in coated tablets;
6. Ramoclav in coated tablets;
7. Taromentin film-coated tablets, powder for solution for injection and infusion and powder for oral suspension.

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