Amoxiclav interaction with other antibiotics. Amoxiclav overdose - symptoms and side effects

In this article, you can read the instructions for using the drug Amoxiclav. Reviews of site visitors - consumers are presented this medicine, as well as the opinions of doctors of specialists on the use of Amoxiclav in their practice. A big request to actively add your reviews about the drug: did the medicine help or not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Amoxiclav, if available structural analogues. Use for the treatment of various infectious diseases in adults, children, as well as during pregnancy and lactation. Alcohol use and possible consequences after taking Amoxiclav.

Amoxiclav- is a combination of amoxicillin - a semi-synthetic penicillin with a wide spectrum of antibacterial activity and clavulanic acid - an irreversible beta-lactamase inhibitor. Clavulanic acid forms a stable inactivated complex with these enzymes and provides amoxicillin resistance to the effects of beta-lactamases produced by microorganisms.

Clavulanic acid, similar in structure to beta-lactam antibiotics, has a weak intrinsic antibacterial activity.

Amoxiclav has a wide spectrum of antibacterial action.

Active against amoxicillin-sensitive strains, including strains producing beta-lactamase, incl. aerobic gram-positive bacteria, aerobic gram-negative bacteria, anaerobic gram-positive bacteria, gram-negative anaerobes.

Pharmacokinetics

The main pharmacokinetic parameters of amoxicillin and clavulanic acid are similar. Both components are well absorbed after oral administration, food intake does not affect the degree of absorption. Both components are characterized by a good volume of distribution in body fluids and tissues (lungs, middle ear, pleural and peritoneal fluids, uterus, ovaries, etc.). Amoxicillin also penetrates into the synovial fluid, liver, prostate, palatine tonsils, muscle tissue, gallbladder, secret paranasal sinuses nose, saliva, bronchial secretions. Amoxicillin and clavulanic acid do not penetrate the BBB in non-inflamed meninges. Amoxicillin and clavulanic acid cross the placental barrier and are excreted in breast milk in trace concentrations. Amoxicillin and clavulanic acid are characterized by low plasma protein binding. Amoxicillin is partially metabolized, clavulanic acid appears to be extensively metabolized. Amoxicillin is excreted by the kidneys almost unchanged by tubular secretion and glomerular filtration. Clavulanic acid is excreted by glomerular filtration, partly as metabolites.

Indications

Infections caused by susceptible strains of microorganisms:

• infections of the upper respiratory tract and ENT organs (including acute and chronic sinusitis, acute and chronic otitis media, retropharyngeal abscess, tonsillitis, pharyngitis);
• infections of the lower respiratory tract (including acute bronchitis with bacterial superinfection, chronic bronchitis, pneumonia);
• infections urinary tract;
• gynecological infections;
• skin and soft tissue infections, including animal and human bites;
• bone and connective tissue infections;
• infections biliary tract(cholecystitis, cholangitis);
• odontogenic infections.

Release form

Powder for the preparation of an injection solution for intravenous administration (4) 500 mg, 1000 mg.

Powder for suspension for oral administration 125 mg, 250 mg, 400 mg (a convenient children's form of the drug).

Film-coated tablets 250 mg, 500 mg, 875 mg.

Instructions for use and dosage

Adults and children over 12 years of age (or over 40 kg body weight): The usual dose for mild to moderate infections is 1 tablet 250 + 125 mg every 8 hours or 1 tablet 500 + 125 mg every 12 hours for severe infections. and respiratory tract infections - 1 tablet 500 + 125 mg every 8 hours or 1 tab. 875 + 125 mg every 12 hours. Tablets are not prescribed for children under 12 years of age (less than 40 kg of body weight).

The maximum daily dose of clavulanic acid (in the form potassium salt) is for adults - 600 mg, for children - 10 mg / kg of body weight. The maximum daily dose of amoxicillin is 6 g for adults and 45 mg/kg of body weight for children.

The course of treatment is 5-14 days. The duration of the course of treatment is determined by the attending physician. Treatment should not continue for more than 14 days without a second medical examination.

Dosage for odontogenic infections: 1 tab. 250 +125 mg every 8 hours or 1 tab. 500 + 125 mg every 12 hours for 5 days.

Dosage for renal insufficiency: for patients with moderate renal insufficiency (Cl creatinine - 10-30 ml / min), the dose is 1 table. 500 + 125 mg every 12 hours; for patients with severe renal insufficiency (Cl creatinine less than 10 ml / min), the dose is 1 table. 500 + 125 mg every 24 hours

Side effect

Side effects in most cases are mild and transient.

• loss of appetite;
• nausea, vomiting;
• diarrhea;
• stomach ache;
• itching, urticaria, erythematous rash;
• angioedema;
• anaphylactic shock;
• allergic vasculitis;
• exfoliative dermatitis;
• Stevens-Johnson syndrome;
• reversible leukopenia (including neutropenia);
• thrombocytopenia;
• hemolytic anemia;
• eosinophilia;
• dizziness, headache;
• convulsions (may occur in patients with impaired renal function when taking the drug in high doses);
• sense of anxiety;
• insomnia;
• interstitial nephritis;
• crystalluria;
• development of superinfection (including candidiasis).

Contraindications

• hypersensitivity to any of the components of the drug;
• a history of hypersensitivity to penicillins, cephalosporins and other beta-lactam antibiotics;
• a history of indications of cholestatic jaundice and / or other abnormal liver function caused by taking amoxicillin / clavulanic acid;
• Infectious mononucleosis and lymphocytic leukemia.

Use during pregnancy and lactation

Amoxiclav can be prescribed during pregnancy if there are clear indications.

Amoxicillin and clavulanic acid are excreted in breast milk in small amounts.

special instructions

During the course of treatment, the functions of the hematopoietic organs, liver and kidneys should be monitored.

In patients with severely impaired renal function, an adequate correction of the dosing regimen or an increase in the intervals between dosing is required.

In order to reduce the risk of developing adverse reactions on the part of the gastrointestinal tract, the drug should be taken with food.

Laboratory tests: High concentrations of amoxicillin give a false positive reaction to urine glucose when using Benedict's reagent or Felling's solution. Enzymatic reactions with glucosidase are recommended.

It is forbidden to use Amoxiclav with the simultaneous use of alcohol in any form, since the risk of hepatic disorders is seriously increased when they are simultaneous reception.

Influence on the ability to drive vehicles and control mechanisms

There are no data on the negative effect of Amoxiclav in recommended doses on the ability to drive a car or work with mechanisms.

drug interaction

With the simultaneous use of the drug Amoxiclav with antacids, glucosamine, laxatives, aminoglycosides, absorption slows down, with ascorbic acid it increases.

Diuretics, allopurinol, phenylbutazone, NSAIDs and other drugs that block tubular secretion increase the concentration of amoxicillin (clavulanic acid is excreted mainly by glomerular filtration).

With the simultaneous use of Amoxiclav increases the toxicity of methotrexate.

With the simultaneous use of Amoxiclav with allopurinol, the incidence of exanthema increases.

Co-administration with disulfiram should be avoided.

In some cases, taking the drug may lengthen the prothrombin time, in this regard, care should be taken when prescribing anticoagulants and the drug Amoxiclav.

The combination of amoxicillin with rifampicin is antagonistic (there is a mutual weakening of the antibacterial action).

Amoxiclav should not be used simultaneously with bacteriostatic antibiotics (macrolides, tetracyclines), sulfonamides due to a possible decrease in the effectiveness of Amoxiclav.

Probenecid reduces the excretion of amoxicillin by increasing its serum concentration.

Antibiotics reduce the effectiveness of oral contraceptives.

Antibiotic analogs Amoksiklav

Structural analogues for the active substance:

• Amovicomb;
• Amoxiclav Quiktab;
• Arlet;
• Augmentin;
• Bactoclav;
• Verclave;
• Klamosar;
• Liklav;
• Medoklav;
• Panklav;
• ranclave;
• Rapiclav;
• Taromentin;
• Flemoklav Solutab;
• Ecoclave.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

Amoxiclav (Amoksiklav) refers to antibiotics and is very widely used by specialists for various diseases. This drug is preferred for the treatment of tonsillitis, sinusitis, otitis media, bronchitis, skin and urinary tract infections, cholecystitis, pneumonia, bone and joint infections.

Composition and form of release

• Solid dosage forms. Pills.
• Liquid dosage forms. Injection.
• Powder for suspension.

Amoxiclav tablets:

• 375 mg or 625 mg. The composition contains amoxicillin 250 mg or 500 mg and clavulanic acid 125 mg;
• one bottle - 15 pieces, 1 bottle in a box.

Powder Amoxiclav:

• the dark bottle contains 100 ml of solution;
• in the box 1 bottle with a metered scoop;
• 5 ml of the prepared solution contains 125 mg and 31.25 mg or 250 mg and 62.5 mg of active ingredients, respectively.

Amoxiclav injection solution:

• dry powder 600 mg and 1.2 g in 1 bottle;
• 1 bottle contains amoxicillin 500 mg or 1000 mg and clavulanic acid 100 mg and 200 mg, respectively;
• 5 bottles in one package.

pharmachologic effect

Clavulanic acid provides a stable, inactivated complex with these enzymes and makes amoxicillin resistant to the effects of beta-lactamases produced by microscopic organisms. This acid, whose structure is similar to antibiotics, is a beta-lactam type.

The action of Amoxiclav is effective against bacteria that are vulnerable to its effects. The symbiosis of amoxicillin and clavulanic acid is very unique. The use of an antibiotic leads to the death of bacterial cells, binding them together with surface receptors. Bacteria, on which its influence is directed, begin to get used to and destroy this agent through the enzyme Beta-lactamase. Clavulanic acid also helps to reduce the energy of this enzyme. This led to the fact that Amoxiclav, which includes this unique acid, is used in various fields of medicine.

The instructions note that the combination of amoxicillin and clavulanic acid destroys bacterial strains resistant to amoxicillin. Amoxiclav is endowed with pronounced bacteriostatic and bactericidal properties for all streptococci, echinococci and listeria.

Indications for use Amoxiclav

According to the instructions, the medicine must be taken with the following infectious diseases:

• Infection of the upper and lower respiratory tract;
• Infection in the urinary tract;
• gynecological infections;
• Infection of the skin and soft tissues, including the consequences after the bite of animals and people;
• Infection of the joints and bones;
• Entering the body of sexually transmitted infections;
• The drug is very often used in the treatment of combined infections:
• peritonitis;
• Cholangitis;
• cholecystitis.

Amoxiclav is used for complications that have appeared in postoperative period surgical intervention on organs abdominal cavity:

• Infection of the abdominal cavity;
• oral infections;
• pneumonia;
• Otitis, tonsillitis and chronic sinusitis;
• Abscesses of the pharynx and abscess of the mammary glands;
• Osteomyelitis, expressed in a bright chronic form.

For surgical prophylaxis:

• Abdominal;
• colorectal;
• Gynecological;
• Urological;
• Maxillary;
• Surgical intervention in the head and neck area.

Contraindications

According to the instructions, Amoxiclav has the following side effects:

• If there were previously violations in the activity of the liver. And extremely rarely the drug is prescribed to patients with various diseases liver, accompanied by destabilization of its functional activity.
• Very rarely and with great care, an antibiotic is prescribed for diseases of the colon, since taking the remedy can cause a sharp exacerbation.
• In the most extreme cases, Amoxiclav is prescribed for patients with kidney disease, accompanied by renal failure.
• Amoxiclav is prohibited for lymphocytic leukemia.
• It is dangerous to prescribe the drug for mononucleosis, because. after taking the medicine, a measles-like rash appears, and this makes it difficult to correctly diagnose the disease.
• Human intolerance to one of the components that make up the product.
• With extreme caution, the drug is prescribed during the entire pregnancy and during breastfeeding.

When side effects during the use of an antibiotic, you should immediately consult a doctor to replace the antibiotic with a similar, but not causing side effects. Otherwise, irreversible processes may occur in the human body that can lead to death.

Side effects

Amoxiclav may cause side effects that affect different systems and human organs, and they are expressed as follows:

Intestinal tract. Violation of digestion and synthesis of individual vitamins (B and K) - bloating, lack of appetite, urge to nausea and nausea itself, unstable stools, alternating diarrhea with constipation. The stomach, duodenum, gallbladder and pancreas suffer from side effects.

Liver. Violation of liver function, and sometimes cause drug-induced jaundice.

Kidneys. The drug has a toxic effect on the efficiency of the kidneys, which leads to inflammatory processes in them and the formation of stones in the pathways that excrete urine.

Central nervous system. Amoxiclav can cause persistent headaches, dizziness, tremorotic twitches and convulsions are possible when using the drug.

Circulatory system. It blocks the synthesis of leukocytes, as a result, immunity decreases. And with the suppression of platelet synthesis, there is a decrease in blood clotting and the appearance of bleeding. Also, red blood cells under its influence can stick together, which leads to severe hemolytic anemia.

Allergic reactions. Urticaria, angioedema. But such reactions are quite rare.

Instructions for use

Amoxiclav should be taken immediately after a meal. With mild or moderate forms infectious disease the norm of use is 375 milligrams (1 tablet) every 8 hours, or 625 (1 tablet) milligrams every 12 hours. For patients with severe disease or infection of the respiratory system, 625 (1 tablet) milligrams every 8 hours, or 1000 (1 tablet) milligrams every 12 hours.

Maximum daily rate the dose of the drug should not exceed 6 grams. The duration of treatment is not more than two weeks. After the end of the treatment course, you do not need to go to the doctor for a re-examination. Odontogenic infection - 375 (1 tablet) milligrams every 8 hours, go to 625 (1 tablet) milligrams every 12 hours. The course of taking the medicine is 5 days.

Renal failure of moderate severity - 625 milligrams (1 tablet) every 12 hours. Renal failure in severe form - 625 milligrams (1 tablet) every 24 hours. Anuria - the interval of taking the medicine is 48 hours or more.

Amoxiclav tablets:

Before use, the tablet must be removed from the blister and dissolved in water. Enough half a glass of chilled boiled water. Or, you can chew it when you take it and drink it with water. Do not drink carbonated water, as water with gas negatively affects the body's perception of this antibiotic, which greatly reduces its effectiveness.

Amoxiclav in ampoules:

In cases where Amoxiclav in tablets does not give the expected effect, or it is necessary to cure the patient in a shorter time, this medication in the form of intravenous injections.

An intravenous infusion of the antibiotic Amoxiclav is done into a vein located in the area of ​​​​the elbow joint. When administering the drug, care must be taken to ensure that it does not get under the skin. Otherwise, various allergic reactions may occur. The drug should be administered slowly over 30-60 minutes. The one-time consumption rate is 1.2 grams. The interval between injections is 8 hours.

Amoxiclav for children

The pediatrician sets the norm for each child personally and it depends on the severity of the course of the disease and the location of the infection. When prescribing, sensitivity to the drug, age and the state of his health are taken into account. It is very important to strictly follow the dose prescribed by the doctor.

It is recommended to take Amoxiclav for children under 12 years of age in the form of:

• suspensions;
• Syrupov;
• Capel.

It is taken orally three times in 24 hours.

A one-time dose of the drug depends on the age of the child:

• From 7 to 12 years old - 250 milligrams;
• From 2 to 7 years old - 125 milligrams;
• From 9 months to 2 years - 62.5 milligrams.

With a severe course of the disease, the rate must be doubled.

Water is used to prepare suspension, syrup and drops.

Amoxiclav should be taken with water, milk or fruit juices. Children should swallow the tablet whole, without chewing it.

If a child has gastritis or various indigestion, then the antibiotic should be taken with food.

During pregnancy and lactation

The use of Amoxiclav during pregnancy and lactation is possible, but only in cases where the expected effect outweighs the possible risk.

Interaction with other drugs

• Indirect anticoagulants;
• Allopurinol;
• Metatrexate;
• Rifampicin;
• Tetracycline;
• Sulfanilamide;
• Contraceptives.

Domestic and foreign analogues

Domestic pharmacies sell drugs whose actions are similar to Amoxiclav. These include:

• Flemoklav;
• Oksamp;
• Amoxivan;
• Fibell;
• Tazocin;
• Bactoclav;
• Arlet.

All these medicines have been tested in domestic laboratories and approved by the Russian Ministry of Health. Their cost is low and they are available to everyone.

Price in pharmacies

The price of Amoxiclav in different pharmacies can vary significantly. This is due to the use of cheaper components and the pricing policy of the pharmacy chain.

Read the official information about the drug Amoxiclav, the instructions for use of which include general information and treatment regimen. The text is provided for informational purposes only and is not a substitute for medical advice.

Description

Powder from white to yellowish color.

Compound

Active ingredients: amoxicillin and clavulanic acid.
Amoxiclav 500 mg/100 mg: each vial contains 500 mg of amoxicillin in the form of sodium salt and 100 mg of clavulanic acid in the form of potassium salt. The ratio is 5:1.
Amoxiclav 1000 mg/200 mg: each vial contains 1000 mg of amoxicillin in the form of sodium salt and 200 mg of clavulanic acid in the form of potassium salt. The ratio is 5:1.
Excipients: none.

Pharmacotherapeutic group

Antibacterial drugs for systemic use; combinations of penicillins, including beta-lactamase inhibitors.
ATX code: J01CR02.

Pharmacological properties

Pharmacodynamics
Amoxicillin is a semi-synthetic penicillin (beta-lactam antibiotic) that inhibits one or more enzymes (often called penicillin-binding proteins) during the biosynthesis of peptidoglycan, an integral component of the bacterial cell wall. Inhibition of peptidoglycan synthesis results in a loss of cell wall strength, which usually results in cell lysis and death.
Amoxicillin is destroyed by the action of beta-lactamases produced by resistant bacteria, therefore it is inactive against microorganisms that produce these enzymes.
Clavulanic acid is a beta-lactam structurally similar to penicillins. It inhibits some beta-lactamases and thus prevents the inactivation of amoxicillin. By itself, clavulanic acid does not have a clinically useful antibacterial effect.
The time to maintain the concentration above the minimum inhibitory (T> MIC) is recognized as the main determinant of the effectiveness of amoxicillin.
Mechanisms of resistance
There are two main mechanisms of bacterial resistance to amoxicillin/clavulanic acid:
inactivation by bacterial beta-lactamases insensitive to the inhibitory action of clavulanic acid, including beta-lactamases of classes B, C and D;
a change in penicillin-binding proteins, as a result of which the affinity of antibacterial drugs for target structures decreases.
Bacterial impermeability or mechanisms for active drug transport out of the bacterial cell can directly cause or contribute to resistance, especially in Gram-negative bacteria.
Sensitivity limits
Minimum inhibitory concentrations for amoxicillin/clavulanic acid comply with the detection limits set by the European Committee for the Evaluation of Antibiotic Susceptibility (EUCAST)

Microorganism	Limits of sensitivity (µg/ml)
	Sensitivity	Intermediate sensitivity	resistance
Haemophilus influenzae 1	≤ 1	-	> 1
Moraxella catarrhalis 1	≤ 1	-	> 1
Staphylococcus aureus 2	≤ 2	-	> 2
Coagulase-negative staphylococci 2	≤ 0,25		> 0,25
Enterococcus 1	≤ 4	8	> 8
Streptococcus A, B, C, G 5	≤ 0,25	-	> 0,25
Streptococcus pneumoniae 3	≤ 0,5	1-2	> 2
Enterobacteria 1.4	-	-	> 8
Gram-negative anaerobes 1	≤ 4	8	> 8
Gram-positive anaerobes 1	≤ 4	8	> 8
Non-species-specific limits 1	≤ 2	4-8	> 8
1 The values ​​obtained correspond to the concentrations of amoxicillin. For the purpose of sensitivity assessment, a fixed concentration of clavulanic acid is used - 2 mg / l. 2 The values ​​obtained correspond to the concentrations of oxacillin. 3 Limit values in the table are based on ampicillin sensitivity limits. 4 The resistance limit, R > 8 mg/l, guarantees the antibiotic resistance of all isolated strains with resistance mechanisms. 5 Limit values ​​in the table are based on sensitivity limits for benzylpenicillin.

The prevalence of resistance of individual species is geographically and temporally dependent, and therefore, before starting therapy, it is desirable to obtain local information on antibiotic resistance, especially in the case of severe infections. In cases where local indicators of antibiotic resistance cast doubt on the appropriateness of the drug for at least some types of infections, you should seek the help of appropriate specialists.
Usually sensitive species
Gram-positive aerobes: Enterococcus faecalis, Gardnerella vaginalis, Staphylococcus aureus(methicillin-susceptible strains) £, Streptococcus agalacticae, Streptococcus pneumoniae 1, Streptococcus pyogenes and other beta-hemolytic streptococci, group Streptococcus viridans
Gram-negative aerobes: Actinobacillus actinomycetemcomitans, Capnocytophaga spp., Eikenella corrodens, Haemophilus influenzae 2, Moraxella catarrhalis, Neisseria gonorrhoea §, Pasteurella multocida
Anaerobes: Bacteroides fragilis, Fusobacterium nucleatum, Prevotella spp.
Species with possible development of acquired resistance
Gram positiveaerobes: Enterococcus faecium $
Gram negativeaerobes: Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Proteus vulgaris
Species with natural resistance
Gram-negative aerobes: Acinetobacter sp., Citrobacter freundii, Enterobacter sp., Legionella pneumophila, Morganela morganii, Providencia spp, Pseudomonas sp., Serratia sp., Stenotrophomonas maltophilia
Othermicroorganisms: Chlamydophila pneumoniae, Clamydophila psittaci, Coxiella burnetti, Mycoplasma pneumoniae
$ Natural intermediate susceptibility in the absence of an acquired resistance mechanism.
£ All methicillin-resistant staphylococci are resistant to amoxicillin/clavulanic acid
§ All strains with non-beta-lactamase resistance to amoxicillin are resistant to amoxicillin/clavulanic acid.
1 Infections caused by penicillin-resistant strains of Streptococcus pneumonia should not be treated with this dosage form of the drug (see "Doses and method of application" and "Special instructions and precautions"),
2 In some EU countries, strains with reduced sensitivity have been identified, occurring at a frequency above 10%.
Pharmacokinetics
With intravenous bolus administration of the combined drug to groups of healthy volunteers at doses of 500 mg / 100 mg or 1000 mg / 200 mg, the average maximum serum concentrations were 32.2 and 105.4 μg / ml for amoxicillin and 10.5 and 28.5 μg / ml for clavulanic acid, respectively. The T 1/2 values ​​were 1.07 and 0.9 hours for amoxicillin and 1.12 and 0.9 hours for clavulanic acid, respectively. The AUC values ​​were 25.5 and 76.3 hmg/l for amoxicillin and 9.2 and 27.9 hmg/l for clavulanic acid, respectively. And urinary excretion (in %, from 0 to 6 hours) was 66.5 and 77.4 for amoxicillin and 46.0 and 63.8 for clavulanic acid, respectively. Approximately 25% of the total plasma clavulanic acid and 18% of the total plasma amoxicillin is in a protein-bound state. The apparent volume of distribution is about 0.3-0.4 l/kg for amoxicillin and about 0.2 l/kg for clavulanic acid.
After intravenous administration, amoxicillin and clavulanic acid are found in the gallbladder, abdominal wall tissues, skin, adipose tissue, muscle tissues, synovial and peritoneal fluids, bile and pus. Amoxicillin only slightly penetrates into the cerebrospinal fluid.
In preclinical studies, there was no evidence of a significant delay in the derivatives of both active medicinal substances in tissues. Amoxicillin, like most penicillins, passes into breast milk. Trace amounts of clavulanic acid are also determined in breast milk(See "Pregnancy and breastfeeding").
Amoxicillin is partially excreted in the urine in the form of inactive penicillic acid in amounts equivalent to a maximum of 10-25% of the original dose. Clavulanic acid is extensively metabolized in the human body, excreted in urine and feces, and also in the form carbon dioxide with exhaled air.
The amoxicillin/clavulanic acid combination has a mean half-life of about one hour and a mean total clearance of about 25 L/h in healthy volunteers. Approximately 60-70% of amoxicillin and approximately 40-65% of clavulanic acid are excreted unchanged in the urine in the first 6 hours after intravenous bolus administration of single doses of 500/100 mg or 1000/200 mg. According to the results of various studies, the level of excretion in the urine within a 24-hour period is 50-85% for amoxicillin and 27-60% for clavulanic acid. The maximum volume of clavulanic acid is excreted in the first two hours after the administration of the drug.
Age
The half-life of amoxicillin in children aged three months to two years, older children and adults is similar. In very young children (including premature newborns) in the first week of life, the drug should not be administered more than twice a day due to the immaturity of the renal excretion pathway. In elderly patients, the dose is selected with caution due to the possible decrease in kidney function and, if necessary, regularly check the work of the kidneys.
Impaired kidney function
The total plasma clearance of amoxicillin and clavulanic acid decreases in proportion to the decrease in renal function. The decrease in clearance is more pronounced for amoxicillin compared to clavulanic acid, since a higher proportion of amoxicillin is excreted by the kidneys. Thus, the doses used in renal failure should prevent excessive accumulation of amoxicillin while maintaining adequate levels of clavulanic acid (see "Doses and route of administration").
Liver failure
In patients with hepatic insufficiency, the drug is prescribed with caution and regularly monitor liver function.

Indications for use

Amoxiclav is indicated for the treatment of the following infections in adults and children:
- severe otorhinolaryngological infections (such as mastoiditis, peritonsillar abscess, epiglottitis, sinusitis in the presence of severe signs of systemic manifestations of diseases);
- exacerbation of chronic bronchitis (diagnosed properly);
- community-acquired pneumonia;
- cystitis;
- pyelonephritis;
- infections of the skin and soft tissues, in particular inflammation of the subcutaneous fat, wounds from animal bites, severe tooth abscesses with widespread phlegmon;
- infections of bones and joints, in particular osteomyelitis; intra-abdominal infections;
- genital infections in women.
Prevention of infections associated with major surgical interventions in adults, including operations in the following areas:
- gastrointestinal tract;
- pelvic cavity;
- head and neck;
- bile ducts.
Consideration should be given to official guidelines on the appropriate use of antibacterial drugs.

Contraindications

• Hypersensitivity to the active substances of the drug or any penicillins.
• History of severe immediate-type hypersensitivity reactions (eg, anaphylaxis) to other beta-lactam drugs (eg, cephalosporins, carbapenems, or monobactams).
• History of jaundice or other liver damage associated with the use of amoxicillin / clavulanic acid.

Precautionary measures

Prior to the start of therapy, a thorough history is taken for hypersensitivity reactions to penicillins, cephalosporins, or other beta-lactam drugs (see "Contraindications" and "Side Effects").
Serious and occasionally fatal hypersensitivity reactions (anaphylactoid reactions) have been observed during penicillin therapy. They are most likely to develop in patients with hypersensitivity reactions to penicillins and a history of atopy. In the event of an allergic reaction, Amoxiclav therapy is discontinued and other suitable antibacterial drugs are prescribed.
In cases of proven susceptibility of infectious agents to amoxicillin, the option of switching from Amoxiclav to amoxicillin should be considered in accordance with official guidelines.
This dosage form of the drug is unsuitable for use if there is high risk that putative pathogens have resistance to beta-lactam drugs not mediated by beta-lactamases sensitive to the inhibitory effect of clavulanic acid.
Since specific data for T > MIC are not available, and data for comparable formulations are borderline, this formulation (without additional amoxicillin) may not be suitable for the treatment of penicillin-resistant infections. S. pneumoniae.
Seizures may develop in patients with impaired renal function and in patients receiving high-dose therapy.
Therapy with Amoxiclav should be avoided in case of suspected infectious mononucleosis, since after the use of amoxicillin against the background of this disease, the appearance of a measles-like rash was observed.
The concomitant use of allopurinol during treatment with amoxicillin potentially increases the likelihood of skin allergic reactions.
Long-term use drug may lead to overgrowth of non-susceptible microorganisms.
The development of generalized erythema with fever and the formation of pustules at the beginning of therapy is a potential symptom of acute generalized exanthematous pustulosis (AGEP) (see "Side Effects"). Such a reaction requires discontinuation of Amoxiclav therapy and is a contraindication to the subsequent administration of amoxicillin.
Treatment of patients with hepatic insufficiency is carried out with caution.
Adverse events from the liver were observed mainly in men and elderly patients and are potentially associated with long-term treatment. These adverse events in very rare cases were observed in children. In all groups of patients, signs and symptoms usually develop during or shortly after treatment, but in some cases they do not appear until a few weeks after stopping therapy. They are usually reversible. Serious adverse events from the liver may develop, extremely rarely with fatal. They were almost always observed among patients with serious underlying diseases or taking concomitant drugs that can affect the liver (see "Side effects").
Cases of antibiotic-associated colitis observed during therapy with almost all antibacterial drugs, including amoxicillin, can vary in severity from mild to life threatening(see "Side effects"). It is important to consider this diagnosis in patients with diarrhea during or after completion of any course of antibiotic therapy. In the event of the development of antibiotic-associated colitis, Amoxiclav therapy is immediately stopped, a doctor is consulted and appropriate treatment is carried out. In this situation, the use of drugs that depress peristalsis is contraindicated.
During long-term therapy, periodic evaluation of the functions of various organ systems, including the kidneys, liver, and hematopoietic organs, is recommended.
In rare cases, while taking the drug, prolongation of prothrombin time was noted. When taking anticoagulants at the same time, proper monitoring of coagulation parameters is mandatory. Dose adjustment of oral anticoagulants may be required to achieve the desired level of anticoagulation.
In patients with renal insufficiency, dose adjustment is mandatory in accordance with the level of insufficiency (see "Doses and method of administration").
In patients with reduced diuresis, crystalluria was observed in rare cases, mainly against the background of parenteral therapy. Sufficient fluid intake is recommended during high-dose amoxicillin therapy to reduce the likelihood of amoxicillin-associated crystalluria. In patients with a catheter installed in the bladder, it is imperative to regularly monitor its patency.
During treatment with amoxicillin, the assessment of urinary glucose levels is carried out using enzymatic methods with glucose oxidase, since non-enzymatic methods sometimes give false positive results.
The presence of clavulanic acid in Amoxiclav can cause non-specific binding of IgG and albumin to erythrocyte membranes, which can lead to false positive Coombs test results.
There have been cases of positive results enzyme immunoassay(IFA) on Aspergillus in patients treated with the drug, in whom the absence of induced Aspergillus infections. Cross-reactions with non-Aspergillus polysaccharides and polyfuranoses have been noted in the ELISA test for Aspergillus. Positive test results in patients taking Amoxiclav should be interpreted with caution and confirmed by other diagnostic methods.
Amoxiclav 1000 mg/200 mg powder for injection contains 1 mmol potassium (39 mg). This should be considered in patients with reduced renal function or in patients on a controlled potassium diet.
Amoxiclav 500 mg/100 mg powder for injection contains less than 1 mmol of potassium (less than 39 mg), i.e. it is essentially a potassium-free drug.
Amoxiclav 1000 mg/200 mg powder for injection contains approximately 2.7 mmol sodium (63 mg). This should be considered in patients on a controlled sodium diet.
Amoxiclav 500 mg/100 mg powder for injection contains approximately 1.4 mmol sodium (31.5 mg). This should be considered in patients on a controlled sodium diet.

Pregnancy and lactation

Limited data on the use of the drug during pregnancy do not indicate an increased risk of congenital anomalies. In women with preterm preterm rupture of membranes, prophylactic treatment with amoxicillin/clavulanic acid has been potentially associated with an increased risk of neonatal necrotizing enterocolitis. The use of the drug during pregnancy should be avoided unless the doctor considers treatment necessary.
Both active substances are excreted in breast milk (data on the effect of clavulanic acid on breastfed babies are not available). Breastfed children may develop diarrhea and fungal infections of the mucous membranes, which may require discontinuation breastfeeding. Therapy with the drug during breastfeeding is possible only after assessing the benefit-risk ratio by the attending physician.

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Influence on the ability to drive vehicles and work with mechanisms

The effect on the ability to manage transport and mechanisms has not been studied. However, the development of undesirable effects (for example, allergic reactions, dizziness, seizures) that potentially affect the performance of these functions is possible.

Doses and method of application

Doses reflect the content of amoxicillin/clavulanic acid, unless indicated that the dose corresponds to the content of a single component.
When choosing a dose for the treatment of specific infections, the following factors are considered:
- suspected pathogens and their possible susceptibility to antibacterial drugs;
- severity and localization of infection;
– age, body weight and kidney function, as indicated below.
The possibility of using other dosage forms of the drug (for example, with higher doses of amoxicillin and / or with a different ratio of doses of amoxicillin / clavulanic acid) is considered as necessary.
This dosage form of the drug, when used in accordance with the recommendations below, provides a total daily dose of amoxicillin 3,000 mg and 600 mg of clavulanic acid. If a higher daily dose of amoxicillin is needed, it is recommended to choose another intravenous dosage form of the drug in order to prevent the introduction of excessively high daily doses of clavulanic acid.
The duration of therapy is determined by the response to treatment. Some infections (such as osteomyelitis) require longer treatment. The duration of treatment should not exceed 14 days without revision (see information on long-term therapy in the section "Special instructions and precautions").
Local guidelines on the appropriate frequency of administration of amoxicillin/clavulanic acid should be considered.

Treatment of infections listed in the section " Therapeutic indications»: 1,000 mg/200 mg every 8 hours.
Intraoperative prophylaxis
For surgical interventions lasting less than 1 hour, the recommended doses are from 1,000 mg / 200 mg to 2,000 mg / 200 mg during induction of anesthesia (doses of 2,000 mg / 200 mg can be achieved through the use of other intravenous dosage forms of the drug).
For surgical interventions lasting more than 1 hour, the recommended doses are from 1,000 mg / 200 mg to 2,000 mg / 200 mg during induction of anesthesia, a maximum of three times at a dose of 1,000 mg / 200 mg in 24 hours. Intraoperative identification of clear clinical signs infections necessitates the usual course of intravenous or oral antibiotic therapy in the postoperative period.
Children with body weight< 40 кг
Recommended doses
Children 3 months of age and older: 25 mg/5 mg per kg every 8 hours.
Children under three months of age or weighing less than 4 kg: 25 mg/5 mg per kg every 12 hours.
Elderly patients
Dose adjustment is not required.
kidney failure
Dose adjustment is based on the maximum recommended level of amoxicillin.
Patients with creatinine clearance (CC) above 30 ml / min dose adjustment is not required.
Adults and children weighing ≥ 40 kg Children with body weight< 40 кг
Liver failure
The therapy is carried out with caution. Regular monitoring of liver function is required (see "Contraindications" and "Special Instructions and Precautions").
Mode of application
For intravenous administration.
The drug is administered as a slow intravenous injection over 3-4 minutes directly into a vein or through a dropper, or as an infusion over 30-40 minutes. The drug is not intended for intramuscular injection.
For children under the age of three months, Amoxiclav can only be administered as an infusion.
Treatment with Amoxiclav may be started with an intravenous dosage form and completed with an oral dosage form if deemed appropriate for the individual patient.
For intravenous injection
Amoxiclav 500 mg / 100 mg: the contents are diluted with water for injection in a volume of 10 ml. Amoxiclav 1000 mg / 200 mg: the contents are diluted with water for injection in a volume of 20 ml. The resulting solution has a light straw color.
The solution must be used or diluted for intravenous infusion immediately, within 20 minutes after preparation. Only a clear solution is suitable for administration.
For intravenous infusion
Amoxiclav 500 mg/100 mg diluted solution (in 10 ml water for injection) is added to 50 ml infusion medium, and Amoxiclav 1000 mg/200 mg diluted solution (in 20 ml water for injection) is added to 100 ml infusion medium .
The diluted solution has a light straw color.
The chemical and physical stability of the resulting solution is maintained for 2-3 hours at a temperature of 25°C and 8 hours at a temperature of 5°C. From a microbiological point of view, the resulting solution for intravenous infusion should be used immediately. The duration of the infusion is about 30-40 minutes.
Incompatibility
The drug should not be mixed with blood and its derivatives, other proteinaceous fluids such as protein hydrolysates or intravenous lipid emulsions. If Amoxiclav is prescribed simultaneously with an aminoglycoside, antibiotics should not be mixed in the same syringe, dropper, or any other infusion system, since under these conditions, loss of aminoglycoside activity may occur.
Amoxiclav is less stable in infusion solutions containing glucose, dextran or bicarbonates.
Do not mix with others medicines.
Due to the inactivating effect of amoxicillin on aminoglycosides, avoid mixing them. in vitro.

Side effect

Overdose

Perhaps the development of gastrointestinal symptoms, as well as a violation of water and electrolyte balance. There have been cases of amoxicillin-associated crystalluria, sometimes leading to renal failure.
Seizures may develop in patients with impaired renal function or receiving high-dose therapy.
Amoxicillin precipitates in urinary catheters, mainly after intravenous administration of large doses. It is necessary to regularly monitor the patency of catheters.
Violations by gastrointestinal tract are treated symptomatically, with due attention to the restoration of water and electrolyte balance. Amoxicillin and clavulanic acid can be excreted from the body by hemodialysis.

Interaction with other medicinal products and other forms of interaction

Oral anticoagulants
Cases of an increase in the international normalized ratio have been described in patients receiving maintenance therapy with acenocoumarol or warfarin against the background of the prescribed course of amoxicillin. If necessary, the simultaneous administration of drugs carefully monitor the prothrombin time or international normalized ratio at the beginning and after stopping treatment with amoxicillin. Dose adjustment of oral anticoagulants may be required.
Methotrexate
Penicillins can reduce the excretion of methotrexate, which is accompanied by an increase in toxicity.
probenecid
The concomitant use of probenecid is not recommended. It reduces the secretion of amoxicillin in the renal tubules. The concomitant use of probenecid with Amoxiclav may lead to an increase in the levels of amoxicillin (but not clavulanic acid) in the blood and their longer maintenance.
Mycophenolate mofetil
In patients taking mycophenolate mofetil, after the start of oral administration of the drug amoxicillin and clavulanic acid, an approximately 50% decrease in the concentration of the active metabolite - mycophenolic acid (MPA) - was observed before taking the next dose of mycophenolate mofetil. Such a change in the concentration of MFC before taking the next dose cannot indicate a change in the overall exposure of MFC. Therefore, in the absence of clinical signs of graft dysfunction, there is usually no need to change the dose of mycophenolate mofetil. However, during such combination therapy and some time after the end of antibiotic therapy, careful medical supervision is necessary.

Release form

Stability at 25°C Stability at 5°C Water for injections 4 hours 8 ocloc'k Sodium chloride solution 0.9% for intravenous infusion 4 hours 8 ocloc'k Ringer's lactate solution for intravenous infusion 3 hours Potassium chloride solution (1 M) or sodium chloride (1 M) 3 hours For storage at 5 ° C, Amoxiclav solution for intravenous injection can be added to pre-chilled infusion bags containing water for injection or sodium chloride solution 0.9%, after which they can be stored for up to 8 hours at 5 ° C. Infusion should be started immediately after the resulting solution reaches room temperature.
The stability of Amoxiclav solutions for intravenous injection depends on the concentration. In the case of using more concentrated solutions, the stability period must be determined accordingly.
Amoxiclav for intravenous injection is less stable in solutions containing glucose, dextran or bicarbonate.

Shelf life

2 years. Do not use after the expiry date stated on the package.

Holiday conditions

Released by prescription. For hospital use only.

Owner registration certificate
Lek d.d., Verovshkova 57, Ljubljana, Slovenia.

Manufacturer
Sandoz GmbH, Biochemistrasse 10, Kundl, Austria.

Amoxiclav - antibacterial drug penicillin group. This is a complex tool of a new generation, which has a powerful antimicrobial activity for most pathogenic bacteria. Due to this, the medicine has an extensive scope of use, and is successfully used to treat many diseases. Read on about Amoxiclav, the forms of its release, what helps, side effects and contraindications.

Composition and action

The main active ingredients are amoxicillin and clavulanic acid. The combination of these active substances provides a pronounced therapeutic effect of the antibiotic. Thanks to clavulanic acid, Amoxiclav can also be prescribed for infections resistant to the action of amoxicillin.

The antibacterial drug has a pronounced bactericidal and bacteriostatic effect on almost all types of streptococci (with the exception of methicillin-resistant strains), listeria, echinococci. Gram-negative bacteria are also sensitive to the drug: Klebsiella, Brucella, Moraxella, Salmonella, Gardnerella, Proteus, Clostridium and others.

The maximum concentration of the antibiotic is reached within 1 hour after taking the drug. The active substances, regardless of the method of administration, are rapidly distributed in the tissues and body fluids (middle ear, lungs, uterus, ovaries, peritoneal and pleural fluids, adipose and muscle tissues, sinuses, tonsils, and so on).

The drug is excreted from the body through the kidneys (half-life in healthy kidneys is 1-1.5 hours). A small amount of clavulanic acid metabolites is excreted in exhaled air and feces.

The drug does not penetrate the membrane of the brain and cerebrospinal fluid, this feature significantly reduces the risk of unpleasant adverse reactions from the central nervous system.

Release form

• Amoxiclav tablets - 250 milligrams of amoxicillin / 125 milligrams of clavulanic acid, 500 milligrams / 125 milligrams and 875 milligrams / 125 milligrams, respectively;
• tablets Amoxiclav Quiktab - 500 milligrams / 125 milligrams, 875 milligrams / 125 milligrams, dispersed tablets;
• Amoxiclav for parenteral administration - powder for the preparation of a solution for injection into a vein of 600 milligrams (500 milligrams of amoxicillin and 100 milligrams of clavulanic acid) or 1.2 grams in a vial (1000 milligrams of amoxicillin and 200 milligrams of clavulanic acid);
• suspension powder - 125 milligrams of amoxicillin and 31.25 milligrams of clavulanic acid per 5 milliliters and 250 milligrams of amoxicillin and 62.5 milligrams of clavulanic acid per 5 milliliters.

Indications for use

• ENT infections and infectious diseases of the upper respiratory tract (pharyngeal abscess, pharyngitis, scarlet fever, otitis media, tonsillitis, sinusitis, chronic and acute sinusitis, laryngitis, tracheitis, tonsillitis).
• Infections of the lower respiratory tract (chronic and acute bronchitis, pneumonia).
• Infections of the biliary tract (cholangitis, cholecystitis).
• Urinary tract infections (cystitis, prostatitis, pyelonephritis, urethritis and others).
• Gynecological diseases of infectious origin (adnexitis, inflammation of the appendages, endometritis and others).
• Odontogenic infections, including periodontitis.
• Venereological infections (syphilis, ureaplasma, gonorrhea, including those provoked by gonococci).
• Chancroid.
• Infections of soft tissues and skin, including wound infections (furunculosis and so on).
• Joint and bone infections.
• Orthopedic practice.
• Infections of the lymphatic system (lymphadenitis and others).
• Mixed infections that are caused by gram-negative and gram-positive microorganisms, anaerobic pathogens (breast abscess, mastitis, postoperative abdominal infections, aspiration pneumonia).

Amoxiclav is also used in dentistry (with flux, stomatitis, and so on) and for the prevention of purulent-septic complications during surgical interventions on the organs of the abdominal cavity, small pelvis, kidneys, bile ducts, heart muscle.

How to use

The exact dosage regimen is set by the doctor on an individual basis, depending on the severity of the disease and the therapeutic effect. The duration of antibiotic treatment is from 5 to 14 days.

Pills

It is taken orally immediately before meals, swallowed whole, without chewing and washed down with water.

According to the instructions, adults and children weighing over 40 kilograms with lung pathologies and moderate appoint 1 tablet (250 milligrams / 125 milligrams) every 8 hours (3 times a day) or 1 tablet (500/125 milligrams) every 12 hours (2 times a day); in a severe form of the disease, it is prescribed - 1 tablet of 500 milligrams / 125 milligrams every 8 hours (three times a day) or 1 tablet of 875 milligrams / 125 milligrams every 12 hours (twice a day).

Amoxiclav Quiktab tablets

Before use, the tablet must be dissolved in 100-150 milliliters of water and mixed well. Adults and children from 12 years of age are prescribed 1 tablet (500 milligrams / 125 milligrams) 2-3 times a day; at severe conditions- 1 tablet (875 milligrams / 125 milligrams) twice a day.

Powder for parenteral use

To prepare a solution for intravenous administration, dissolve the contents of the vial in water for injection (for Amoxiclav 600 milligrams - 10 milliliters; for Amoxiclav 1.2 grams - 20 milliliters). Further, the resulting solution is injected intravenously slowly over 4-5 minutes.

If the drug is to be administered as an intravenous infusion, then 600 milligrams of the drug is dissolved in 10 milliliters of water for injection and added to the infusion solution (50 milliliters). Antibiotic 1.2 grams is dissolved in 20 milliliters of water for injection and added to 100 milliliters of infusion solution. Drip drug is administered for 30-40 minutes. Freezing of the product is prohibited.

Suspension

Shake the powder bottle well, add warm boiled water (up to the mark) in 2 passes, shaking each time until the powder is completely dissolved.

In pediatrics, newborns and infants up to 3 months old are prescribed a medicine at the rate of 30 milligrams per 1 kilogram of weight (daily dose), this amount must be divided and given in 2 doses at regular intervals.

From 3 months, the antibiotic is prescribed at a dose of 25 milligrams per 1 kilogram of body weight, it is also divided equally into 2 doses. In infectious diseases of moderate severity, 20 milligrams per 1 kilogram of body weight are prescribed and divided into 3 injections. In severe conditions, the dose is increased - 45 milligrams per 1 kilogram of weight and divided into 2 injections per day.

Contraindications

• lymphocytic leukemia;
• Infectious mononucleosis;
• cholestatic jaundice or hepatitis resulting from the use of antibacterial drugs of the penicillin group;
• hypersensitivity to antibiotics of the cephalosporin group, penicillins and other beta-lactam drugs;
• hypersensitivity to clavulanic acid or amoxicillin.

With caution, the drug is prescribed for severe renal dysfunction, renal failure and patients with a history of pseudomembranous colitis.

Side effects

• allergic reactions: urticaria, itching, erythematous rash; in rare cases - angioedema, allergic vasculitis, anaphylactic shock, Stevens-Johnson syndrome, exfoliative dermatitis.
• From the side digestive tract : possible nausea, loss of appetite, diarrhea, vomiting; rarely - pain in the abdomen, impaired liver function; in isolated cases, hepatitis, cholestatic jaundice, pseudomembranous colitis may develop.
• From the side nervous system : headache, dizziness; rarely - hyperactivity, insomnia, anxiety, convulsions (may occur in patients with impaired renal function when using the drug in high doses).
• From the hematopoietic system: rare cases of reversible leukopenia (including neutropenia), thrombocytopenia; in isolated cases, hemolytic anemia, pancytopenia, eosinophilia develop, a reversible increase in prothrombin time (with simultaneous use with anticoagulants).
• From the urinary system: rarely - crystalluria, interstitial nephritis.
• Other: candidiasis.

During pregnancy

Antibacterial drug is not recommended during pregnancy. Exceptions are cases where the benefit of treatment outweighs the potential harm to the fetus. Taking Amoxiclav during pregnancy increases the risk of developing necrotizing colitis in newborns.

It is undesirable to take the drug during lactation, since clavulanic acid and amoxicillin are excreted in breast milk in small quantities. If mothers nevertheless prescribed medication, it is worthwhile to stop breastfeeding for a while. Otherwise, the child may develop diarrhea, allergic reactions, and so on.

For kids

Children under 12 years of age and weighing less than 40 kilograms are prescribed an antibiotic in the form of a suspension. Recommended dosages are listed above.

With alcohol

During drug therapy, it is forbidden to use alcoholic drinks. Alcohol intake significantly reduces the antibacterial effect of the drug and makes it difficult to excrete it through the kidneys.

Analogues

Substitutes for the active substance: Amovikomb, Arlet, Augmentin, Amoxicillin + Clavulanic acid, Baktoclave, Verklav, Klamosar, Liklav, Medoklav, Panklav, Ranklav, Rapiclav, Taromentin, Flemoclav Solutab, Ecoclave.

Analogues according to the mechanism of action:

Amoxicillin (Amoxicillin Sandoz, Amosin, Ecobol, Ranoxyl)

Release form - tablets, capsules, powder for injection, suspension; the active substance is amoxicillin.

Bactericidal antibacterial drug from the group of semi-synthetic penicillins. It has wide range action and is used to treat bacterial infections: pneumonia, bronchitis, tonsillitis, urethritis, pyelonephritis, gonorrhea and other caused by drug-sensitive microorganisms.

The dosage is selected individually. For oral administration, adults and children from 12 years of age (or weighing more than 40 kilograms) are prescribed 250-500 milligrams, with a severe course of the disease - up to 1 gram; children 5-10 years old - 250 milligrams; 2-5 years - 125 milligrams; up to 2 years, the daily dose is 20 milligrams per kilogram of body weight. Between doses of the drug should be at least 8 hours. For children under 12 years of age, it is recommended to use Amoxicillin in the form of a suspension.

For parenteral use, adults are injected intramuscularly at 1 gram twice a day; children - 50 milligrams / kilogram / day, single - 500 milligrams, frequency of administration - 2 times a day.

Side effects: erythema, angioedema, conjunctivitis, anaphylactic shock, joint pain, fever.

Contraindications: hypersensitivity to penicillins, infectious mononucleosis. With caution, the antibiotic is prescribed to pregnant women and patients prone to allergic reactions.

Ampiox (Oxampicin, Oxamp)

Release form - capsules, powder for solution preparation; active ingredients - ampicillin sodium, oxacillin sodium.

The antibacterial drug belongs to semi-synthetic penicillins and is active against gram-negative (meningococcus, E. coli, gonococcus, salmonella, and so on) and gram-positive (streptococcus, pneumococcus, staphylococcus) microorganisms. Indications for use are: tonsillitis, pyelonephritis, sinusitis, tonsillitis, pneumonia, otitis media, meningitis, cystitis, cervicitis and so on.

Capsules are taken orally before meals, swallowed whole and washed down with water. Adults and adolescents from the age of 14 are prescribed 0.5-1.0 grams (2-4 capsules); 7-14 years - 50 milligrams / kilogram / day; 3-7 years - 100 milligrams / kilogram / day; The daily dose is divided into 4-6 doses. The duration of treatment is 7-14 days.

Intravenous and intramuscular (drip, jet) daily dose for adults and adolescents from 14 years of age is 3-6 grams; children 7-14 years old - 100 milligrams / kilogram / day; 1-6 years - 100 milligrams / kilogram / day; newborns, premature babies and babies under 1 year old - 100-200 milligrams / kilogram / day. The daily dose must be administered in 3-4 doses, with an interval of 6-8 hours. According to the indications, the dose can be increased by 1.5-2 times.

Side effects: rhinitis, hyperemia of the skin, arthralgia, conjunctivitis, vomiting, diarrhea, nausea, leukopenia, enterocolitis, anemia, angioedema.

Contraindications: lymphocytic leukemia, infectious mononucleosis, hypersensitivity. Use with caution in chronic insufficiency, in children born to a mother with intolerance to penicillins.

Ampisid (Sultasin, Sulacillin, Libaccyl, Ampicillin + Sulbactam, Sulbacin)

Release form - powder, tablets; active ingredients - ampicillin, sulbactam.

A combined antibiotic of the penicillin group is prescribed to patients of all age groups in infectious diseases caused by microorganisms sensitive to ampicillin and sulbactam. Among them are infections: respiratory organs (pleurisy, bronchitis, bacterial pneumonia), ENT organs (otitis media, sinusitis, tonsillitis), urinary and reproductive system organs (cystitis, pyelonephritis, adnexitis, and so on), gastrointestinal organs (cholangitis, pancreatitis, cholecystitis ), musculoskeletal system (myositis, arthritis, osteomyelitis), skin and subcutaneous tissue (burn wounds, erysipelas, infected dermatoses), prevention of postoperative infections.

Tablets are administered orally before meals, 1-2 hours in a daily dose of 375-750 milligrams for adults and 25-50 milligrams per kilogram of body weight for children whose weight does not exceed 30 kilograms. The daily dose of the drug must be divided into 2 doses.

Intramuscularly and intravenously (drip at a rate of 60-80 drops per minute, jet - slowly, for 3-4 minutes). Intravenously injected for 5-7 days, if you need to continue treatment, then switch to intramuscular use. With a mild infection for adults - 1.5-3 grams per day in 2 injections; with an average course - 3-6 grams per day in 3-4 injections; severe course - 12 grams per day in 3-4 injections. For children, the daily dose is taken at the rate of 150 milligrams per 1 kilogram of weight, the frequency of administration is 3-4 times; newborns and premature babies - every 12 hours. The duration of therapy is 5-14 days.

Side effects: loss of appetite, nausea, vomiting, diarrhea, anemia, leukopenia, drowsiness, headache, flushing of the skin, urticaria, rhinitis, eosinophilia, candidiasis (with prolonged use).

Contraindications: lactation period, infectious mononucleosis, hypersensitivity. With caution in hepatic and / or renal failure, pregnancy.

Clonacom-X

Release form - capsules; active ingredients - amoxicillin trihydrate, cloxacillin sodium.

The drug is active against most gram-positive and gram-negative bacteria. It is prescribed for infections of the upper respiratory tract, pneumonia, bronchitis, infections of the gastrointestinal tract, urinary tract, skin and soft tissues, gonorrhea, and so on.

Capsules are taken before meals, washed down with water, swallowed whole, without chewing. Adults are prescribed 1 capsule every 6-8 hours, depending on the severity of the disease. In case of impaired renal function, the dose is reduced.

Side effects: nausea, diarrhea, skin rashes, in rare cases, pseudomembranous colitis (intestinal colic) may develop.

Contraindications: childhood, pregnancy, lactation, infectious mononucleosis, hypersensitivity to active substances. Use with caution in patients with allergic reactions.

Tazocin (Tazrobida, Piperacillin + Tazobactam Teva)

Release form - lyophilisate for solution; active ingredients - piperacillin, tazobactam.

A bactericidal semi-synthetic broad-spectrum antibacterial drug is effective for moderate and severe infections: bacterial infections of the lower and upper respiratory tract, abdominal organs, complicated and uncomplicated pathologies of the skin and soft tissues, abscess, pelvic organs, bacterial septicemia (blood infection by bacteria), joint and bone infections.

The drug is administered intravenously drip (slowly over 30 minutes) or intramuscularly. The daily dose in adults and adolescents from 12 years of age with normal kidney function is 2.25 grams every 6 hours or 4.5 grams every 8 hours; children 2-12 years old - 90 milligrams per 1 kilogram of body weight every 6 hours. For patients undergoing hemodialysis (blood purification method), the maximum dose is 2.25 grams every 8 hours. The duration of therapy is 7-10 days.

Side effects: vomiting, nausea, development of intestinal colic, itching, urticaria, rashes, erythema, headache, convulsions, hypoglycemia, phlebitis, hypotension, flushing of the skin of the face, fever, rarely - arthralgia and others.

Contraindications: hypersensitivity, age up to 2 years. With caution in severe bleeding (history), pregnancy, lactation, cystic fibrosis, hypokalemia, pseudomembranous enterocolitis.

Timentin

Release form - lyophilisate for solution preparation; active ingredients - ticarcillin, clavulanic acid.

The antibiotic has a wide spectrum of action and is indicated for the treatment of infections of the connective and bone tissue, in gynecology, skin and subcutaneous tissue, urinary tract, and so on.

The drug is administered intravenously drip or jet. The intervals between infusions should be at least 4 hours. Therapy should be continued for 48-72 hours after the symptoms disappear.

For adults and adolescents weighing over 40 kilograms, the average dose is 3 grams every 6 hours or 5 grams every 8 hours. The maximum dose is 3 grams every 4 hours. Children weighing less than 40 kilograms are prescribed 75 milligrams/kg every 8 hours (maximum 75 milligrams every 6 hours); premature babies weighing less than 2 kilograms - 75 milligrams every 12 hours, those weighing more than 2 kilograms - 75 milligrams every 8 hours. In case of impaired renal function, the dose is adjusted.

Side effects: diarrhea, nausea, vomiting, hepatitis, cholestatic jaundice, convulsions, leukopenia, decreased hemoglobin levels, eosinophilia, urticaria, rashes, itching, anaphylactic reactions, skin redness, burning sensation, and so on.

Contraindications: premature babies with impaired renal function, hypersensitivity to active substances, pregnancy, lactation.

Amoxiclav: instructions for use and reviews

Amoxiclav is a combined antibiotic medication.

Release form and composition

Amoxiclav is produced in the form of:

• Coated tablets containing 250 mg, 500 mg or 875 mg of amoxicillin, 125 mg of clavulanic acid and excipients: colloidal silicon dioxide, crospovidone, croscarmellose sodium, magnesium stearate, talc, MCC. In blisters and dark glass bottles;
• Powder for the preparation of a suspension for oral administration containing 5 ml of the finished suspension of amoxicillin and clavulanic acid in the ratio of 125 mg / 31.25 mg, 250 mg / 62.5 mg, 400 mg / 57 mg and excipients: citric acid, sodium citrate , MCC and carmellose sodium, xanthan gum, colloidal silicon dioxide, wild cherry flavor and lemon flavor, sodium saccharinate, mannitol. In dark glass bottles;
• Powder for solution for injection containing 1 vial of amoxicillin and clavulanic acid in the ratio of 500 mg / 100 mg, 1000 mg / 200 mg.

Pharmacological properties

Pharmacodynamics

Amoxicillin is a semi-synthetic penicillin that affects many gram-negative and gram-positive microorganisms. It inhibits the biosynthesis of peptidoglycan, a component that is part of the structure of the bacterial cell wall. A decrease in the production of peptidoglycan causes a decrease in the strength of cell walls, which further leads to lysis and death of cells of pathogens. At the same time, amoxicillin is sensitive to the action of beta-lactamases, which destroy it, so its spectrum of antibacterial activity does not include microorganisms that synthesize this enzyme.

Clavulanic acid is a beta-lactamase inhibitor whose structure is similar to that of penicillin. It has the ability to inactivate numerous beta-lactamases that produce microorganisms with proven resistance to cephalosporins and penicillins. The relative effectiveness of clavulanic acid against plasmid beta-lactamases, which most often cause antibiotic resistance in bacteria, has been proven. However, the substance does not act on chromosomal type I beta-lactamases that are not inhibited by clavulanic acid.

The presence of clavulanic acid in Amoxiclav prevents the destruction of amoxicillin by special enzymes - beta-lactamases - and expands the spectrum of antibacterial activity of amoxicillin.

Clinical studies in vitro prove high sensitivity to the action of Amoxiclav of the following microorganisms:

• gram-negative anaerobes: varieties of the genus Prevotella, Bacteroides fragilis, other subspecies of the genus Bacteroides, varieties of the genus Porphyromonas, varieties of the genus Capnocytophaga, varieties of the genus Fusobacterium, Fusobacterium nucleatum, Eikenella corrodens;
• gram-positive anaerobes: varieties of the genus Peptostreptococcus, Peptostreptococcus magnus, Peptostreptococcus micros, Peptococcus niger, varieties of the genus Clostridium;
• gram-negative aerobes: Vibrio cholerae, Bordetella pertussis, Pasteurella multocida, Haemophilus influenza, Neisseria gonorrhoeae, Moraxella catarrhalis, Helicobacter pylori;
• gram-positive aerobes: coagulase-negative staphylococci (showing sensitivity to methicillin), Staphylococcus saprophyticus (strains sensitive to methicillin), Staphylococcus aureus (strains sensitive to methicillin), Bacillus anthracis, Streptococcus agalactiae, Streptococcus pyogenes and other streptococci of the beta-hemolytic group, Enterococcus faecalisoccus , Nocardia asteroids, Listeria monocytogenes;
• others: Treponema pallidum, Leptospira icterohaemorrhagiae, Borrelia burgdorferi.

The following microorganisms are characterized by acquired resistance to the active components of Amoxiclav:

• gram-positive aerobes: streptococci of the Viridans group, Streptococcus pneumoniae, Enterococcus faecium, bacteria of the genus Corynebacterium;
• gram-negative aerobes: bacteria of the genus Shigella, Escherichia coli, bacteria of the genus Salmonella, bacteria of the genus Klebsiella, Klebsiella pneumoniae (clinical studies confirm the effectiveness of the active ingredients of Amoxiclav in relation to this microorganism, also its strains do not synthesize beta-lactamase), Klebsiella oxytoca, bacteria of the genus Proteus , Proteus vulgaris, Proteus mirabilis.

Natural resistance to the combination of amoxicillin and clavulanic acid is demonstrated by such microorganisms:

• gram-negative aerobes: bacteria of the genus Acinetobacter, Yersinia enterocolitica, Citrobacter freundii, Stenotrophomonas maltophilia, bacteria of the genus Enterobacter, bacteria of the genus Pseudomonas, Hafnia alvei, bacteria of the genus Serratia, Legionella pneumophila, bacteria of the genus Providencia, Morganella morganii;
• others: bacteria of the genus Mycoplasma, Chlamydophila psittaci, Chlamydophila pneumoniae, bacteria of the genus Chlamydia, Coxiella burnetii.

The sensitivity of bacteria to amoxicillin monotherapy most often means similar sensitivity to the combination of amoxicillin and clavulanic acid.

Pharmacokinetics

The main pharmacokinetic parameters of amoxicillin and clavulanic acid are largely similar. Both substances show good solubility in aqueous solutions having physiological significance pH, and after oral administration of Amoxiclav, they are rapidly and almost completely absorbed from the gastrointestinal tract. The degree of absorption of clavulanic acid and amoxicillin is considered optimal if the drug is taken at the beginning of a meal.

After oral administration, the bioavailability of the active components of Amoxiclav reaches 70%.

When prescribing a drug in various doses, the pharmacokinetic parameters of amoxicillin and clavulanic acid are as follows:

• at a dosage of 875 mg / 125 mg 2 times a day for amoxicillin: the maximum plasma concentration is 11.64 ± 2.78 μg / ml, the time to reach it is 1.5 hours (range is from 1 to 2.5 hours) , area under the concentration-time curve (AUC) - 53.52 ± 12.31 μg h / ml, half-life - 1.19 ± 0.21 hours; for clavulanic acid: maximum plasma concentration - 2.18 ± 0.99 μg / ml, time to reach it - 1.25 hours (range is from 1 to 2 hours), area under the concentration-time curve (AUC) – 10.16 ± 3.04 µg×h/ml, elimination half-life – 0.96 ± 0.12 hours;
• at a dosage of 500 mg / 125 mg 2 times a day for amoxicillin: the maximum concentration in blood plasma is 7.19 ± 2.26 μg / ml, the time to reach it is 1.5 hours (range is from 1 to 2.5 hours) , area under the concentration-time curve (AUC) - 53.5 ± 8.87 μg h / ml, half-life - 1.15 ± 0.2 hours; for clavulanic acid: maximum plasma concentration - 2.4 ± 0.83 μg / ml, time to reach it - 1.5 hours (range is from 1 to 2 hours), area under the concentration-time curve (AUC) – 15.72 ± 3.86 µg×h/ml, elimination half-life – 0.98 ± 0.12 hours;
• at a dosage of 250 mg / 125 mg 3 times a day for amoxicillin: the maximum plasma concentration is 3.3 ± 1.12 μg / ml, the time to reach it is 1.5 hours (range is from 1 to 2 hours), the area under curve "concentration - time" (AUC) - 26.7 ± 4.56 μg h / ml, half-life - 1.36 ± 0.56 hours; for clavulanic acid: maximum plasma concentration - 1.5 ± 0.7 μg / ml, time to reach it - 1.2 hours (range is from 1 to 2 hours), area under the concentration-time curve (AUC) - 12.6 ± 3.25 μg h / ml, half-life - 1.01 ± 0.11 hours.

All the above values ​​are obtained from clinical studies in healthy volunteers.

Amoxicillin and clavulanic acid have a high volume of distribution in various tissues, organ systems and body fluids (including muscle, bone and adipose tissue, abdominal organs, lungs, interstitial, peritoneal, synovial and pleural fluid, sputum, bile, purulent discharge, urine and skin).

Active ingredients moderately bind to plasma proteins: amoxicillin in the amount of 18% and clavulanic acid in the amount of 25% of the dose taken. The volume of distribution is approximately 0.2 L/kg for clavulanic acid and 0.3–0.4 L/kg for amoxicillin. Both substances do not cross the blood-brain barrier in the absence of inflammation of the meninges. Amoxicillin, like many penicillins, passes into breast milk, which also contains clavulanic acid in trace concentrations. The active components of Amoxiclav penetrate the placental barrier.

Approximately 10-25% of the initial dose of amoxicillin is excreted in the urine as penicillic acid, which has no pharmacological activity. Clavulanic acid is extensively metabolized in the body, forming 1-amino-4-hydroxy-butan-2-one and 2,5-dihydro-4-(2-hydroxyethyl)-5-oxo-1H-pyrrole-3-carboxylic acid, which excreted through the gastrointestinal tract, kidneys, and also with exhaled air (turning into the form of carbon dioxide).

Amoxicillin is eliminated predominantly by renal filtration, while clavulanic acid is eliminated by both renal and extrarenal mechanisms. After a single oral dose of 1 tablet of 500 mg / 125 mg or 250 mg / 125 mg, about 40-65% of clavulanic acid and 60-70% of amoxicillin are excreted unchanged in the urine during the first 6 hours.

On average, the half-life of the active components of Amoxiclav is approximately 1 hour, and the average total clearance is approximately 25 l / h in healthy patients. Most of the clavulanic acid is excreted from the body during the first 2 hours after ingestion.

In patients with renal dysfunction, the total clearance of clavulanic acid and amoxicillin decreases in proportion to the decrease in renal function. The decrease in clearance is more pronounced with amoxicillin than with clavulanic acid, since most of the dose of amoxicillin is excreted through the kidneys. In renal insufficiency, the dose of Amoxiclav should be selected taking into account the undesirability of amoxicillin accumulation against the background of a stable concentration of clavulanic acid that meets the standards. In patients with severe renal insufficiency, the half-life of amoxicillin increases to 7.5 hours, and clavulanic acid - up to 4.5 hours.

In patients with liver dysfunction, Amoxiclav is prescribed with caution, and constant monitoring of liver function is also recommended. Both amoxicillin and clavulanic acid are removed by hemodialysis, and in small concentrations by peritoneal dialysis.

Indications for use

According to the instructions, Amoxiclav is prescribed for the treatment of infectious and inflammatory diseases caused by drug-sensitive microorganisms. The drug is indicated for gynecological, odontogenic infections, as well as infections:

• ENT organs and upper divisions respiratory tract, including acute and chronic sinusitis, otitis media, tonsillitis, pharyngeal abscess, pharyngitis;
• Connective and bone tissue;
• Lower respiratory tract, including chronic bronchitis, acute bronchitis with bacterial superinfection, pneumonia;
• urinary tract;
• Skin and soft tissues, including animal and human bites;
• bile ducts.

The use of Amoxiclav in the form of injections is indicated:

• With infections of the abdominal cavity;
• With sexually transmitted infections - gonorrhea, soft chancre;
• To prevent the development of infections after surgical interventions.

Contraindications

Amoxiclav is not prescribed for cholestatic jaundice and hepatitis associated with the use of penicillin antibiotics. In addition, the remedy is contraindicated in:

• sensitivity to penicillin preparations, clavulanic acid, amoxicillin, other components of Amoxiclav;
• infectious mononucleosis;
• Lymphoid leukemia.

Amoxiclav is prescribed with caution when:

• History of pseudomembranous colitis;
• liver failure;
• Severe impairment of kidney function.

The possibility of using Amoxiclav by pregnant and lactating women should be decided individually with the doctor.

Instructions for use Amoxiclav: method and dosage

Tablets and solution for suspension for oral administration

The regimen of taking the drug and the duration of therapy is determined depending on the severity of the infection, the age, kidney function of the patient and body weight. In tablets and suspensions, Amoxiclav is recommended to be taken with meals, which will reduce the risk of developing side effects from the digestive system.

The average course of treatment is from 5-14 days. Longer treatment is possible only after a second medical examination.

The recommended dosage regimen for Amoxiclav tablets for children under 12 years of age is 40 mg / kg per day, which is divided into 3 doses. Children weighing more than 40 kg are shown adult dosages of the drug. For children under 6 years of age, it is preferable to use Amoxiclav suspension.

There are two schemes for taking Amoxiclav by adults with mild and moderate infections:

• Every 8 hours, 1 tablet 250+125 mg;
• Every 12 hours, 1 tablet 500+125 mg.

Against the background of a severe course of infection and with infections of the respiratory tract, one tablet of 500 + 125 mg should be taken every 8 hours or every 12 hours, 1 tablet of 875 + 125 mg.

For odontogenic infections, 1 tablet Amoxiclav 250+125 mg every 8 hours or 1 tablet 500+125 mg every 12 hours is indicated for 5 days.

Newborns and children under 3 months of age Amoxiclav is prescribed as a suspension at the rate of 30 mg / kg per day (according to amoxicillin). The medicine is taken every 12 hours. To comply with the dosage, use the dosing pipette supplied with the package.

The daily dosage of Amoxiclav for children older than 3 months is:

• With mild and moderate severity of the course of the disease - from 20 mg / kg per day;
• In severe infections and in the treatment of infections of the lower respiratory tract, otitis media, sinusitis - up to 40 mg / kg (amoxicillin) per day.

It should be borne in mind that when calculating dosages, it is necessary to rely not on the age of the child, but on his body weight and the severity of the course of the disease.

Injection

Amoxiclav in the form of a solution for injection is administered exclusively intravenously.

For children under 3 months, the dose is calculated based on the following information:

• body weight less than 4 kg: Amoxiclav is administered at a dosage of 30 mg / kg (taking into account the conversion to the entire drug) every 12 hours;
• body weight over 4 kg: Amoxiclav is administered at a dosage of 30 mg / kg (taking into account the conversion to the entire drug) every 8 hours.

Children who have not reached 3 months, the solution for injection should be administered only slowly by infusion over 30-40 minutes.

For children whose body weight does not exceed 40 kg, the dose is selected based on body weight.

For children aged 3 months to 12 years, the drug is administered at a dosage of 30 mg / kg of body weight (in terms of the entire drug) every 8 hours, and in the case of a severe course of an infectious disease - every 6 hours.

In children with diagnosed renal dysfunction, dose adjustments may be required based on the maximum recommended dose of amoxicillin. If in such patients the creatinine clearance exceeds 30 ml / min, a dose change is optional. In other cases, in children whose body weight does not exceed 40 kg, it is recommended to use Amoxiclav in the following dosages:

• CC 10-30 ml / min: 25 mg / 5 mg per 1 kg of body weight every 12 hours;
• CC less than 10 ml / min: 25 mg / 5 mg per 1 kg of body weight every 24 hours;
• hemodialysis: 25 mg/5 mg per kg of body weight every 24 hours in combination with an additional dose of 12.5 mg/2.5 mg per kg of body weight at the end of the dialysis session (associated with a decrease in the concentrations of clavulanic acid and amoxicillin in blood serum).

Each 30 mg of the drug contains 25 mg of amoxicillin and 5 mg of clavulanic acid.

Adults and children over 12 years of age or weighing more than 40 kg Amoxiclav is administered at a dosage of 1200 mg of the drug (1000 mg + 200 mg) every 8 hours, and in the case of an acute course of an infectious disease - every 6 hours.

Amoxiclav is also prescribed for surgical interventions at a prophylactic dose, which is usually 1200 mg during induction anesthesia in cases where the operation lasts less than 2 hours. For longer surgical interventions the patient receives the drug at a dose of 1200 mg up to 4 times for 1 day.

In patients suffering from renal insufficiency, the dose and / or time interval between injections of Amoxiclav should be adjusted depending on the degree of impaired renal function in accordance with the following instructions:

• CC more than 30 ml / min: there is no need for dose adjustment;
• CC 10-30 ml / min: the first dose is 1200 mg (1000 mg + 200 mg), after which the drug is administered intravenously at a dose of 600 mg (500 mg + 100 mg) every 12 hours;
• CC less than 10 ml / min: the first dose is 1200 mg (1000 mg + 200 mg), after which the drug is administered intravenously at a dose of 600 mg (500 mg + 100 mg) every 24 hours;
• anuria: the interval between injections of the drug should be increased to 48 hours or more.

Since up to 85% of the administered dose of Amoxiclav is removed during the hemodialysis procedure, the usual dose of injection solution should be administered at the end of each session. With peritoneal dialysis, there is no need for dose adjustment.

The duration of the course of treatment is from 5 to 14 days (its exact duration can only be determined by the attending physician). With a decrease in the severity of symptoms as a continuation of therapy, it is recommended to switch to oral forms Amoxiclav.

When preparing a solution for injection, the contents of the vial in an amount of 600 mg (500 mg + 100 mg) are dissolved in 10 ml of water for injection, and in an amount of 1200 mg (1000 mg + 200 mg) in 20 ml of water for injection (this volume is not recommended exceed). The drug is administered intravenously slowly (over 3-4 minutes), and the introduction should be carried out within 20 minutes after the preparation of the solution.

Amoxiclav solution can also be used for intravenous infusion. In this case, prepared solutions containing 1200 mg (1000 mg + 200 mg) or 600 mg (500 mg + 100 mg) of the drug are further diluted in 100 ml or 50 ml of the infusion solution, respectively. The duration of the infusion reaches 30-40 minutes.

The use of the following liquids in the recommended volumes allows you to maintain the necessary concentrations of amoxicillin in the infusion solutions. Their periods of stability vary and are:

• for water for injection: 4 hours at 25 °C and 8 hours at 5 °C;
• for solutions of sodium chloride and calcium chloride for intravenous infusion: 3 hours at 25 ° C;
• for Ringer's lactate solution for intravenous infusion: 3 hours at 25 °C;
• for sodium chloride solution 0.9% for intravenous infusion: 4 hours at 25 °C and 8 hours at 5 °C.

Amoxiclav solution should not be mixed with solutions of sodium bicarbonate, dextran or dextrose. Only clear solutions are to be administered. The prepared solution must not be frozen.

Side effects

The use of Amoxiclav can lead to the development of side effects:

• Hematopoietic system: anemia, eosinophilia, thrombocytopenia, agranulocytosis, leukopenia;
• Digestive system: diarrhea, flatulence, gastritis, nausea, dyspepsia, glossitis, stomatitis, anorexia, enterocolitis, vomiting;
• Nervous system: anxiety, inappropriate behavior, overexcitation, convulsions, confusion, insomnia, hyperactivity, dizziness, headache;
• Skin: urticaria, edema, rash; less often - exfoliative dermatitis, epidermal toxic necrolysis, Stevens-Johnson syndrome, erythema multiforme;
• Urinary system: interstitial nephritis, hematuria.

It is also possible to develop superinfection (including candidiasis).

In most cases, side effects against the background of the use of Amoxiclav are mild and transient.

Overdose

There are no reports that an overdose of Amoxiclav provokes serious side effects that threaten life or death.

Most often, an overdose is manifested by such symptoms as disorders of the water and electrolyte balance and impaired functioning of the gastrointestinal tract (vomiting, diarrhea, pain in the abdomen). Sometimes taking amoxicillin can lead to the development of crystalluria, and in the future - renal failure. In patients with renal dysfunction or those receiving the drug in high doses, convulsive seizures are possible.

In case of an overdose of Amoxiclav, the patient should be under the supervision of a specialist who, if necessary, prescribes symptomatic therapy. If Amoxiclav was taken less than 4 hours ago, it is recommended to perform a gastric lavage and take activated charcoal to reduce absorption. The active components of the drug are well excreted from the body through hemodialysis.

special instructions

Taking Amoxiclav with meals reduces the likelihood of side effects from the gastrointestinal tract.

At course therapy it is necessary to control the functions of the liver, hematopoiesis and kidneys.

Against the background of severe renal impairment, the doctor should adjust the dosing regimen or increase the interval between taking the medication.

Influence on the ability to drive vehicles and complex mechanisms

If during treatment with the drug the patient is diagnosed with adverse reactions from the central nervous system (for example, convulsions or dizziness), it is recommended to refrain from driving and performing work that requires increased concentration and immediate psychomotor reactions.

Use during pregnancy and lactation

In the course of animal experiments, the harm of taking Amoxiclav during pregnancy and the effect of the drug on embryonic development fetuses have not been confirmed. In a single study in women with premature rupture of the membranes, it was found that preventive use combinations of amoxicillin and clavulanic acid may increase the risk of necrotizing enterocolitis in newborns.

During pregnancy and lactation, the use of Amoxiclav is recommended only if the potential benefit of treatment for the mother significantly exceeds possible risks for the health of the fetus and child. Clavulanic acid and amoxicillin in small concentrations are found in breast milk. Breastfed infants may develop diarrhea, sensitization, candidiasis of the mucous membranes of the oral cavity, therefore, if treatment with the drug is necessary, it is advisable to stop breastfeeding.

For impaired renal function

Patients with moderate renal failure (CC varies from 10 to 30 ml / min) are recommended to take Amoxiclav 1 tablet (dose 500 mg / 125 mg or 250 mg / 125 mg, depending on the severity of the disease) every 12 hours, and with severe renal failure (CC is less than 10 ml / min) - 1 tablet (dose 500 mg / 125 mg or 250 mg / 125 mg, depending on the severity of the disease) every 24 hours.

The first dose of solution for intravenous administration with CC 10-30 ml / min is 1000 mg / 200 mg, then 500 mg / 100 mg every 12 hours. With CC less than 10 ml / min, the first dose of the solution for intravenous administration is 1000 mg / 200 mg, then 500 mg / 100 mg every 24 hours.

With anuria, the interval between doses of Amoxiclav is increased to 48 hours or more.

For impaired liver function

Patients with impaired liver function should take Amoxiclav with caution. During therapy, it is necessary to regularly monitor liver function.

Use in the elderly

Elderly patients do not need to adjust the dosing regimen.

drug interaction

Reception ascorbic acid together with Amoxiclav enhances the absorption of its active ingredients, and the intake of aminoglycosides, antacids, laxatives, glucosamine reduces their absorption. The use of non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, phenylbutazone, allopurinol and other drugs that block tubular secretion (probenecid) increases the level of amoxicillin in the body (clavulanic acid is eliminated mainly through glomerular filtration). The combination of Amoxiclav and probenecid can lead to an increase and persistence in the blood concentration of amoxicillin, but not clavulanic acid, so the simultaneous use of drugs is prohibited.

The combination of amoxicillin, clavulanic acid and methotrexate enhances the toxic properties of methotrexate. The use of the drug in conjunction with allopurinol can provoke the development of allergic skin reactions. It is not recommended to prescribe Amoxiclav together with disulfiram.

The combination of amoxicillin and clavulanic acid reduces the effectiveness of drugs whose metabolism leads to the formation of para-aminobenzoic acid, and when taken with ethinyl estradiol, the risk of breakthrough bleeding increases.

In the literature, there are isolated reports of an increase in the international normalized ratio (INR) in patients while taking amoxicillin and warfarin or acenocoumarol. If it is necessary to combine Amoxiclav with anticoagulants, regular monitoring of INR or prothrombin time is recommended when canceling or starting treatment with the drug, since dose adjustment of oral anticoagulants may be required.

Co-administration of amoxicillin / clavulanic acid with rifampicin can lead to mutual weakening of the antibacterial action. Amoxiclav is not recommended to be used even once in combination with bacteriostatic antibiotics (tetracyclines, macrolides) and sulfonamides due to the likely decrease in the effectiveness of amoxicillin / clavulanic acid.

Taking the drug leads to a decrease in the effectiveness of oral contraceptives. In patients taking mycophenolate mofetil, after the start of treatment with Amoxiclav, there is a decrease in the content of the active metabolite in the body - mycophenolic acid - by about 50% before taking the next dose of the drug. Variation in its concentration may not accurately reflect overall changes in exposure to a given metabolite.

Analogues

Analogues of Amoxiclav are:

• By active substance- Bactoclav, Klamosar, Arlet, Panklav, Medoklav, Liklav, Augmentin, Rapiclav, Fibell, Ecoclave, Amovikomb, Amoksivan;
• According to the mechanism of action - Libaktsil, Oksamp, Santaz, Ampioks, Tazotsin, Timentin, Sulacillin, Ampisid.

Terms and conditions of storage

The shelf life of tablets and solution is 2 years. Store in a dry place, at a temperature not exceeding 25°C. Keep away from children.

The shelf life of the finished suspension is 7 days. Ready suspension stored at 2-8°C.