Antibiotic Therapy

Introduction to Antibiotic Therapy

The American Academy of Otolaryngology-Head and Neck Surgery recommends high-dose amoxicillin-clavulanate for patients with sinusitis who don't respond to amoxicillin, to cover beta-lactamase-producing H. influenzae and M. catarrhalis 1
The American Academy of Pediatrics recommends high-dose amoxicillin-clavulanate for patients with acute otitis media who have taken amoxicillin in the previous 30 days, those with concurrent conjunctivitis, or when coverage for M. catarrhalis is desired 2

In regions with high incidence of antibiotic resistance, amoxicillin-clavulanate provides coverage against resistant bacteria that amoxicillin alone cannot treat, according to the American Academy of Otolaryngology-Head and Neck Surgery 3
High-dose formulations, such as 4g amoxicillin with 250mg clavulanate per day for adults, may be necessary to overcome resistant pathogens in respiratory infections 3

Clavulanic acid functions as a beta-lactamase inhibitor that preserves the activity of amoxicillin in the presence of beta-lactamase-producing bacteria, thereby extending amoxicillin's antimicrobial spectrum to include organisms that would otherwise be resistant 3
Amoxicillin/clavulanate is effective against beta-lactamase-producing strains of both gram-positive and gram-negative bacteria, including Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Bacteroides fragilis 3

Clavulanic acid is only available as a co-formulation with amoxicillin 4
Pediatric formulations typically provide a 14:1 ratio of amoxicillin to clavulanate in oral suspensions 3
Adult formulations use modified-release mechanisms to provide pharmacokinetically enhanced versions of amoxicillin/clavulanate 3
Twice-daily dosing has significantly fewer gastrointestinal side effects compared to three-times-daily dosing 3

Gastrointestinal side effects, such as diarrhea, can become problematic when the clavulanate dose exceeds approximately 10 mg/kg per day 3

When using carbapenems for multidrug-resistant tuberculosis, clavulanic acid (via amoxicillin-clavulanate) must be given to achieve a dose of 125mg clavulanate with each carbapenem dose 4
Synergistic effects have been observed between meropenem and amoxicillin-clavulanate in extremely drug-resistant tuberculosis 4
Amoxicillin-clavulanate is not recommended for routine treatment of multidrug-resistant tuberculosis except when providing clavulanate for co-administration with carbapenems 4
Completing the full prescribed course of amoxicillin-clavulanate is crucial even if symptoms improve earlier, to prevent treatment failure and potential development of resistance 5