Augmentin – composition, action, indications, dosage, price

Proven content

Augmentin is an antibiotic with a bactericidal effect. It is a prescription drug whose main ingredient is amoxicillin, a semi-synthetic penicillin derivative. Augmentin is used in cases of urinary or respiratory tract infections, as well as infections of the middle ear, skin, soft tissues, bones and joints. How does Augmentin work and when should you use it? What are the contraindications to the use of the drug? Can its use cause side effects? How much does Augmentin cost and are replacements available?

Augmentin – general characteristics of the drug

Augmentin is an antibiotic medicine that works by killing bacteria that cause infections. This preparation contains two other drugs, i.e. amoxicillin and clavulanic acid.

Augmentin is used to treat infections of the respiratory tract, ear, sinuses, urinary tract, skin, tissues, bones and joints.

Augmentin film-coated tablets are capsule-shaped and white to off-white in color. One side is engraved with a score line and “AC”. The drug is packed in blisters in a cardboard box. Each pack of the medicine contains 2, 4, 10, 12, 14, 16, 20, 24, 30, 100 or 500 tablets. The drug may also be available in blisters in sachets in cardboard boxes. The sachets contain an agent that absorbs moisture. Leave the desiccant in the sachet. Each such package contains 14 tablets.

Currently, several pharmaceutical companies are responsible for the production and distribution of Augmentin. These are:

1. Delfarma – is a leader in parallel import. This company supplies the Polish market with cheaper drugs and thus significantly contributes to the reduction of health care costs. The Delfarma company was established in 2004 and offers over 500 drugs. The company’s head office is located in Łódź;
2. Forfarm – direct parallel importer. The company has over 400 licenses for pharmaceutical products. The company Forfarm Sp. z o. o. started its commercial activity in 2006. It is primarily a pharmaceutical wholesaler with an established position on the pharmaceutical market. The main activity of the company is trade in medicinal products under the parallel import procedure and export to licensed entities in the European Union countries. The company’s head office is located in Warsaw;
3. GlaxoSmithKline – is a British pharmaceutical concern established in December 2000 as a result of the merger of Glaxo Wellcome and SmithKline Beecham. In the ranking of the 50 largest pharmaceutical companies for 2012, GSK was placed sixth. The company supplies over 300 drugs, vaccines and health care products to the Polish market. GSK is the largest investor in the pharmaceutical industry in Poland;
4. Inpharm – is a company that has been dealing with parallel import and distribution of medicinal products, medical devices and cosmetics since 2006. The company has an extensive network of suppliers throughout the European Union. The company’s head office is located in Warsaw;
5. Pharmavites – is a company dealing with parallel import on the Polish pharmaceutical market. Since 2011, the company has been building a leading position, cooperating with business partners from the European Union, as well as expanding the portfolio of imported medicinal products, private labels and logistics services. The company’s headquarters is located in Warsaw.

How do antibiotics work and when should you use them? Check: Antibiotics – types, action, use and side effects [EXPLAIN]

Augmentin – composition and action

Augmentin is a bactericidal antibiotic that contains two different drugs: amoxicillin and clavulanic acid in a 4: 1 ratio.

The first ingredient, i.e. amoxicillin, is a semi-synthetic penicillin which acts by inhibiting the activity of one or more enzymes in the synthesis of peptidoglycan. As a result of inhibition of this synthesis, the cell wall is weakened, which causes cell breakdown and death of the bacteria. It is worth mentioning that amoxicillin is susceptible to degradation by β-lactamases produced by resistant bacteria, therefore its scope of action does not include organisms producing these enzymes.

Clavulanic acid, on the other hand, is a β-lactam compound whose structure is largely similar to that of penicillins. Clavulanic acid inactivates some β-lactamases, thereby preventing the breakdown of amoxicillin. This compound, by itself, has no significant antibacterial activity. However, it is important to combine the acid with amoxicillin, which forms a drug with a broad antimicrobial spectrum.

In the characteristics of the drug Augmentin should also pay attention to the main mechanisms of bacterial resistance to amoxicillin administered concomitantly with clavulanic acid. These mechanisms involve inactivation by bacterial β-lactamases and alteration of the structure of penicillin binding proteins. Additionally, the impermeability of the bacterial cell wall or the existence of a pump to remove the drug from the cell plays an important role in the process of acquiring or developing resistance, especially in Gram-negative bacteria.

The resistance of selected microbial species varies with geographic area and time. Therefore, especially when treating serious infections, local data analysis is indicated when assessing resistance.

The susceptible species include: aerobic gram-positive bacteria – E. faecalis, G. vaginalis, S. aureus susceptible to methicillin, methicillin-sensitive coagulase negative staphylococci, S. agalactiae, S. pneumoniae, S. pyogenes, other β-hemolytic streptococci , greening streptococci; Gram-negative aerobes – Capnocytophaga spp., E. corrodens, H. influenzae, M. catarrhalis, P. multocida; anaerobic bacteria – B. fragilis, F. nucleatum, Prevotella spp.

In turn, the non-susceptible species, i.e. with innate resistance, include: Gram-positive aerobes – Acinetobacter spp., C. freundii, Enterobacter spp., L. pneumophila, M. morganii, Providencia spp., Pseudomonas spp., Serratia spp. , S. maltophilia; other – Ch. pneumoniae, Ch. psittaci, C. burnetti, M. pneumoniae.

1 film-coated tablet Augmentin contains 250 mg, 500 mg or 875 mg of amoxicillin as amoxicillin trihydrate and 125 mg of clavulanic acid as potassium clavulanate.

The other ingredients of the film-coated tablets are: magnesium stearate, sodium carboxymethyl starch (type A), colloidal anhydrous silica, microcrystalline cellulose, titanium dioxide (E171), hypromellose, macrogol (4000, 6000) and dimethicone (silicone oil).

In turn, 1 ml of Augmentin prepared oral suspension contains: 80 mg of amoxicillin in the form of amoxicillin trihydrate and 11,4 mg of clavulanic acid in the form of potassium clavulanate.

The other ingredients in Augmentin oral suspension are: crospovidone, silicon dioxide, carmellose sodium, xanthan gum, colloidal anhydrous silica, magnesium stearate, sodium benzoate, aspartame (E951), and strawberry flavor (containing maltodextrin).

What is amoxicillin and what is its use? Check: Amoxicillin

Augmentin – drug metabolism and absorption

The active substances in Augmentin are well and quickly absorbed from the gastrointestinal tract. This absorption is increased if the drug is taken at the beginning of a meal. The maximum concentration of amoxicillin and clavulanic acid occurs approximately one hour after dosing. The blood concentrations of amoxicillin and clavulanic acid following administration of these substances together are similar to those obtained after administration of their respective equivalent doses separately.

It is estimated that approximately 25% of the administered dose of clavulanic acid and 18% of the administered dose of amoxicillin is bound to plasma proteins. These compounds penetrate well through the placenta, into the middle ear, skin, adipose tissue, muscles, synovial fluid, peritoneal fluid, bile or purulent secretions. Amoxicillin also penetrates the cerebrospinal fluid to a clinically insignificant extent. Both amoxicillin and, in trace amounts, clavulanic acid pass into breast milk.

Amoxicillin and qualunal acid are rapidly metabolized. It has been shown that approx. 60–70% of amoxicillin and 40–65% of clavulanic acid are excreted unchanged in the urine within the first 6 hours after dosing. The greatest amount of clavulanic acid is excreted from the body in the first 2 hours after administration. Only about 10-25% of the administered dose of amoxicillin is excreted as inactive penicillic acid. In turn, clavulanic acid is excreted in the urine, in the faeces and also partly as carbon dioxide in the expired air.

What is penicillin and how does it work? Check: Penicillin

Augmentin – indications for use

Augmentin is a preparation that is used in cases of bacterial infections. Your doctor may recommend this medication, especially for the treatment of:

1. acute bacterial sinusitis;
2. cellulitis;
3. severe periodontal abscess with spreading cellulitis;
4. cystitis;
5. pyelonephritis;
6. bites by animals.

Higher doses of drugs, i.e. Augmentin 500 mg and 875 tablets, as well as powder for oral suspension are recommended in the treatment of:

1. the state of exacerbation of chronic bronchitis;
2. acute otitis media;
3. community-acquired pneumonia;
4. skin and soft tissue infections, especially cellulitis;
5. bone and joint infections, especially osteomyelitis.

What bacterial diseases are most often diagnosed? Check: The most common bacterial diseases – overview and characteristics

Augmentin – contraindications to use

Augmentin, despite its effectiveness in the treatment of bacterial infections, cannot be used by every patient struggling with this type of ailments.

Contraindications to the use of Augmentin are:

1. allergy to the active substances of the drug or any of the excipients;
2. hypersensitivity to other penicillins;
3. previous severe allergic reaction to any other antibiotic;
4. liver dysfunction or yellowing after taking an antibiotic.

If these apply to you, you should not take Augmentin. Check with your doctor or pharmacist before starting Augmentin if you are not sure

What should you know about drug hypersensitivity? Check: Drugs are also allergenic

Augmentin – precautions

Before and during the use of Augmentin, you should follow the precautions, which are included in the package leaflet.

Precautions to keep in mind include:

1. check with your doctor or pharmacist before taking Augmentin if you suffer from infectious mononucleosis, are treated for liver or kidney disease, or urinate irregularly;
2. in some cases, your doctor may investigate the type of bacteria that is causing your infection. Depending on the results, the patient may receive Augmentin in a different dose or a different drug;
3. the use of the preparation may worsen the course of some diseases or cause serious side effects, including allergic reactions, convulsions and colitis;
4. if you are having blood tests such as red blood cell status tests or liver function tests or urine tests (for glucose), please tell the doctor or nurse;
5. the drug should be stored in the original packaging in order to protect from moisture, at a temperature not higher than 25 degrees;
6. the drug should be kept out of the reach of children;
7. tablets in blisters placed in sachets should be used within 30 days of opening the sachet;
8. the medicine should not be used after the expiry date which is stated on the carton. The expiry date refers to the last day of that month;
9. this medicine should not be disposed of via wastewater or household waste. It’s best to ask your pharmacist how to dispose of medicines you no longer use.

What should you know about proper drug storage? Check: Medications that are stored wrongly are poisonous

Augmentin – correct dosage

Always use Augmentin exactly as described in the package leaflet or as directed by the doctor or pharmacist.

Augmentin should be taken at the beginning or just before a meal with a glass of water. The Augmentin tablet can be broken in half to make it easier to swallow. Both tablet halves should be taken at the same time. There should be an interval of at least 4 hours between each dose. Augmentin should not be used for more than 2 weeks.

Correct dose of Augmentin for adults and children weighing more than 40 kg is one tablet twice daily. The doctor may decide to use a higher dose, in which case 2 tablet is taken 1 times a day.

Oral tablets should not be administered to children weighing less than 40 kg. Oral suspension is recommended for children weighing less than 40 kg.

Some modifications in the dosage of the drug may require patients who are struggling with kidney and liver diseases. Your doctor may change the dose of your medicine or order tests to check your liver function.

How to take medication correctly? Check: How to take medications effectively?

Augmentin – misuse of the drug

Taking more than the recommended dose of Augmentin or missing the indicated dose during the day is considered inappropriate use of Augmentin.

If you take more than the dose prescribed by your doctor, symptoms such as irritation of the stomach and intestines and seizures may occur.

However, if you miss a dose, take it as soon as you remember to take it. In this case, do not take the next dose too soon. There should always be an interval of four hours between doses. The patient should not take a double dose to make up for a missed dose.

It is also worth remembering that Augmentin should be used until the bacterial infection is fully healed. You shouldn’t stop treatment, even if you feel better. All doses of the drug are important for the successful control of the disease. If some bacteria survive, there is a high risk of the infection returning.

Do you know what diseases we managed to fight thanks to vaccines? Check: 14 diseases that we (almost) forgot thanks to vaccinations

Augmentin – side effects

Augmentin, like any other drug, may cause side effects in patients. It is important to report any suspected adverse reactions after authorization of the medicinal product so that the benefit / risk balance of the medicinal product can be monitored.

The frequency classification 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).

Allergic reactions and gastrointestinal symptoms are among the side effects that may occur with Augmentin.

Allergic reactions include skin rash, inflammation of blood vessels, fever, joint pain, swollen glands in the neck or groin, swelling of the face or throat, difficulty breathing and fainting.

Gastrointestinal symptoms include colitis resulting in watery diarrhea usually with blood and mucus, abdominal pain and fever.

Due to the frequency of side effects, the following are indicated:

1. very common side effects of Augmentin (more than 1 in 10 patients): diarrhea (in adults);
2. common side effects of Augmentin (may affect up to 1 in 10 patients): thrush (candidiasis – a yeast infection of the vagina, mouth, skin folds), nausea, especially with high doses, vomiting and diarrhea (in children);
3. Uncommon side effects of Augmentin (may affect up to 1 in 100 people): skin rash, itching, raised itchy rash (hives), indigestion, dizziness and headache;
4. uncommon side effects of Augmentin may show up in blood tests: increase in some substances (enzymes) produced by the liver.
5. rare side effects of Augmentin (may affect up to 1 in 1000 patients): skin rash, which may blister, and looks like small targets;
6. rare side effects of Augmentin that may show up in blood tests: low number of cells involved in blood clotting and low number of white blood cells.

The use of Augmentin can also cause side effects, the frequency of which is unknown. These side effects include:

1. allergic reactions;
2. Colitis;
3. inflammation of the protective membranes surrounding the brain (aseptic meningitis);
4. severe skin reactions – a widespread skin rash, with blistering and peeling of the skin, especially around the mouth, nose, eyes and genitals. Widespread red skin rash with small blisters (bullous exfoliative dermatitis). A red, scaly rash with bumps under the skin and blisters (acute generalized pustular eruption). Flu-like symptoms with a rash, fever, swollen lymph nodes and abnormal blood test results (including increase in white blood cells and increase in liver enzymes); 
5. hepatitis;
6. jaundice;
7. renal tubular inflammation;
8. prolongation of blood clotting time;
9. motor agitation;
10. seizures;
11. black tongue which looks hairy.

What causes an antibiotic rash? Read on: Antibiotic rash – is it an allergy symptom?

Augmentin – interactions with other drugs

Before starting Augmentin treatment, please inform your doctor or pharmacist about all medicines you are taking or have recently taken. You should also inform what medications the patient plans to take in the near future.

The active substances in Augmentin may interact with other drugs and substances that are contained in medicinal products. The concomitant use of Augmentin with allopurinol for gout significantly increases the patient’s risk of developing skin reactions.

In turn, taking Augmentin and preparations with probenecid at the same time requires the doctor to modify the doses of both preparations.

If you are taking medicines to reduce blood clotting, such as warfarin, your doctor may order additional blood tests.

It is also worth paying attention to methotrexate, which is a component of anti-cancer and anti-rheumatic drugs. Concomitant use of Augmentin may adversely affect the activity of this active substance.

In addition, Augmentin may interfere with the effect of mycophenolate mofetil, a medicine used to prevent rejection of transplants.

It is also worth paying attention to the following drug combinations:

1. Augmentin i Rec. Chloramphenicol, Chloramphenicol (Rec.), Kemicetine i inne – the preparations contain interacting compounds, i.e. amoxicillin and chloramphenicol. The simultaneous use of both drugs may reduce the bactericidal effect of amoxicillin. If you feel that the effect of the drugs is too weak, and the disease persists despite taking them, consult your doctor;
2. Augmentin i Vibramycin, Supracyclin, Dotur, Efracea, Ligosan i inne – the preparations contain interacting compounds, i.e. amoxicillin and doxycycline. The simultaneous use of both drugs may reduce the bactericidal effect of amoxicillin.
3. Augmentin i Minocyclin Ratiopharm – the preparations contain interacting compounds, i.e. amoxicillin and minocycline. Minocycline may reduce the bactericidal effect of amoxicillin;
4. Augmentin i Oxycort Jelfa, Ster-dex, Oxycort — Ir, Oxycort Tzf, Oxycort A, Oxytetracyclini Hydrohloridum (Rec.), Atecortin – the preparations contain interacting compounds, i.e. amoxicillin and oxytetracycline. Oxytetracycline may reduce the bactericidal effect of amoxicillin;
5. Augmentin i Mysteclin, Tetracycline Tzf, Polcortolon Polfa Tarchomin, Juvesan, Tetracycline Chema – the preparations contain interacting compounds, i.e. amoxicillin and tetracycline. Tetracycline may reduce the bactericidal effect of amoxicillin.

Which drugs should never be combined with each other? Check: Dangerous interactions

Augmentin and pregnancy and breastfeeding

The use of any medications or dietary supplements during pregnancy requires consultation with the attending physician. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking Augmentin.

The use of Augmentin should be avoided during pregnancy, unless considered essential by your doctor. The use of Augmentin during pregnancy and breast-feeding is not recommended, as both medicinal substances contained in the preparation are excreted in breast milk.

If this medicine is used by a nursing mother, it is possible for diarrhea and fungal infection of the mucous membranes of the infant to develop, and it may be necessary to stop breast-feeding. The possibility of sensitization should also be taken into account.

What is worth knowing about proper supplementation during pregnancy? Check: Conscious choices. Diet and supplementation in pregnancy

Augmentin — the price of the drug

The price of Augmentin may vary depending on the city in which the antibiotic is purchased or the pharmacy chosen by the patient. The price of the product also depends on the manufacturer responsible for the distribution of the drug and the number of tablets contained in the package.

The price of the Augmentin drug produced by the Delfarma concern have:

1. 14 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 28. After the refund, the price is about PLN 15;
2. 14 film-coated tablets, where the 625 mg tablet contains 500 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 17. After the refund, the price is about PLN 9;

The price of the Augmentin drug produced by the Forfarm concern have:

1. 14 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 26. After the refund, the price is approximately PLN 13;

The price of the Augmentin drug produced by the GlaxoSmithKline concern – Great Britain have:

1. 14 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 31. After the refund, the price is approximately PLN 18;
2. 20 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 38. After the refund, the price is approximately PLN 19;
3. 21 film-coated tablets, where the 375 mg tablet contains 250 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 14. After the refund, the price is about PLN 8;
4. 14 film-coated tablets, where 625 mg tablets contain 500 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 18. After the refund, the price is approx. PLN 10.

The price of the Augmentin drug produced by the Inpharm concern have:

1. 14 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 28. After the refund, the price is about PLN 15;
2. 14 film-coated tablets, where 625 mg tablets contain 500 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 17. After the refund, the price is approx. PLN 10.

The price of the drug Augmentin produced by the Pharmavitae concern have:

1. 14 film-coated tablets, where 1 g of a tablet contains 875 mg of amoxicillin and 125 mg of clavulanic acid, costs about PLN 28. After the refund, the price is about PLN 15.

How much money does the average Pole spend on treatment? Check: The Pole is not expected to see a doctor

Augmentin – replacements

Products that have the same international name and exist in the same form do not have to be substitutes, because the use of a given drug is determined by the content of the active substance, i.e. the dose of the drug.

It should be remembered that even when the dose of the active substance is similar, the patient may not always use the substitute, because he may be allergic to any of the other excipients of the drug.

Therefore, before using a substitute for Augmentin, read the package leaflet or consult your doctor or pharmacist.

The preparations containing the same ingredients as Augmentin and showing similar properties include:

1. Amoksiklav – a drug available in granules or powder for oral suspension, powder for solutions for injection and infusion, and in coated tablets;
2. Amoksiklav Quicktab 625 mg – a drug available in tablets for oral suspension, in orodispersible tablets;
3. Amoksiklav Quicktab 1000 mg – a drug available in tablets for oral suspension, in orodispersible tablets;
4. Amoxicillin + Clavulanic Acid Aurovitas – the drug is available in coated tablets;
5. Amylan – a drug available in coated tablets;
6. Auglavin PPH – a drug available in powder for oral suspension and in coated tablets;
7. Co-amoxiclav Bluefish – the drug is available in coated tablets;
8. Forcid 625 – a drug available in oral tablets and for the preparation of a suspension;
9. Forcid 1000 – a drug available in oral tablets and for the preparation of a suspension;
10. Hiconcil Combi – a drug available in powder for oral suspension and in coated tablets;
11. Penlac – the drug is available in coated tablets;
12. Polamoklav – a drug available in coated tablets;
13. Ramoclav – the drug is available in coated tablets;
14. Taromentin – a drug available in granules or powder for oral suspension, powder for solutions for injection and infusion, and in coated tablets.

When is it worth asking the pharmacy about drug substitutes? Check: Swap when you can