Co-amoxiclav is a broad-spectrum, combination antibiotic formulation designed to combat a wide range of bacterial infections with enhanced efficacy. It combines amoxicillin, a penicillin-class antibiotic, with clavulanic acid, a beta-lactamase inhibitor, to overcome bacterial resistance mechanisms. This synergistic approach ensures reliable treatment outcomes for both community-acquired and more complex infections, making it a first-line choice in empirical and targeted antimicrobial therapy.

Features

• Contains amoxicillin trihydrate equivalent to 500 mg or 875 mg amoxicillin, with clavulanic acid as potassium clavulanate equivalent to 125 mg
• Available in oral tablet, dispersible tablet, and oral suspension formulations
• Exhibits bactericidal activity by inhibiting bacterial cell wall synthesis
• Clavulanic acid component protects amoxicillin from degradation by beta-lactamase enzymes
• Rapid absorption with peak plasma concentrations achieved within 1-2 hours post-administration
• Wide tissue distribution including respiratory tissues, middle ear fluid, and genitourinary system

Benefits

• Effectively treats infections caused by beta-lactamase producing bacteria that are resistant to amoxicillin alone
• Broad spectrum coverage against Gram-positive and Gram-negative aerobes and anaerobes
• Rapid onset of action provides prompt symptomatic relief
• High clinical cure rates in respiratory, urinary, skin, and soft tissue infections
• Well-established safety profile with extensive clinical experience
• Flexible dosing regimens accommodate various infection severities and patient populations

Common use

Co-amoxiclav is indicated for the treatment of bacterial infections caused by susceptible organisms, including:

• Upper and lower respiratory tract infections (sinusitis, otitis media, bronchitis, pneumonia)
• Urinary tract infections (cystitis, pyelonephritis)
• Skin and soft tissue infections (cellulitis, abscesses, wound infections)
• Dental infections (periodontitis, dental abscesses)
• Bone and joint infections (osteomyelitis, septic arthritis)
• Intra-abdominal infections
• Genital tract infections
• Prophylaxis in surgical procedures

Dosage and direction

Dosage varies based on infection severity, pathogen susceptibility, and patient factors:

Adults and children ≥40 kg:

• Mild to moderate infections: 500 mg/125 mg every 12 hours
• Severe infections: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours

Children <40 kg:

• Based on amoxicillin component: 25-45 mg/kg/day divided every 12 hours or 20-40 mg/kg/day divided every 8 hours
• Maximum daily dose: 60 mg amoxicillin/kg/day for severe infections

Renal impairment adjustment:

• CrCl >30 mL/min: standard dosing
• CrCl 10-30 mL/min: 500 mg/125 mg every 12 hours
• CrCl <10 mL/min: 500 mg/125 mg every 24 hours

Tablets should be swallowed whole with water at the start of a meal to enhance absorption and minimize gastrointestinal side effects. The course should be completed even if symptoms improve earlier to prevent recurrence and resistance development.

Precautions

• Use with caution in patients with hepatic impairment due to clavulanate metabolism
• Monitor renal function during prolonged therapy
• May cause false-positive glucose reactions with copper reduction tests
• Prolonged use may result in fungal or bacterial superinfection
• Not recommended for infectious mononucleosis due to increased rash risk
• Use during pregnancy only if clearly needed (Category B)
• Caution in breastfeeding as amoxicillin excretes in breast milk
• Regular liver function monitoring recommended during extended courses

Contraindications

• History of hypersensitivity to penicillins, cephalosporins, or other beta-lactam antibiotics
• Previous co-amoxiclav-associated hepatic dysfunction or cholestatic jaundice
• Patients with phenylketonuria (contains phenylalanine in some formulations)
• History of amoxicillin/clavulanate-associated blood dyscrasias
• Concurrent use with disulfiram (for liquid formulations containing alcohol)

Possible side effect

Common (≥1/100):

• Diarrhea, nausea, vomiting
• Skin rashes, urticaria
• Vaginal candidiasis
• Headache, dizziness

Uncommon (≥1/1000 to <1/100):

• Reversible leukopenia, thrombocytopenia
• Elevated liver enzymes
• Oral thrush, black hairy tongue
• Insomnia, agitation

Rare (<1/1000):

• Hepatitis, cholestatic jaundice
• Stevens-Johnson syndrome, toxic epidermal necrolysis
• Hemolytic anemia, prolongation of bleeding time
• Interstitial nephritis
• Pseudomembranous colitis
• Anaphylaxis, angioedema

Drug interaction

• Probenecid: Reduces renal tubular secretion of amoxicillin, increasing blood levels
• Oral anticoagulants: May enhance anticoagulant effect, monitor INR
• Allopurinol: Increased incidence of skin rashes
• Methotrexate: May decrease methotrexate clearance, increasing toxicity risk
• Oral contraceptives: Possible reduced contraceptive efficacy
• Mycophenolate mofetil: May reduce active metabolite levels
• Tetracyclines, macrolides: May antagonize bactericidal effect

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for the missed one. Maintain regular dosing intervals to ensure consistent antibiotic levels. If multiple doses are missed, contact healthcare provider for guidance on regimen adjustment.

Overdose

Symptoms may include gastrointestinal disturbances (nausea, vomiting, diarrhea), electrolyte imbalances, and central nervous system effects. Management involves symptomatic and supportive care. Hemodialysis may enhance elimination of both components. Maintain adequate hydration and electrolyte balance. Specific antibiotic activity against Clostridium difficile should be considered if diarrhea persists.

Storage

• Store at room temperature (15-30°C) in original container
• Protect from moisture and light
• Oral suspension: Once reconstituted, store refrigerated (2-8°C) and use within 7 days
• Do not freeze liquid formulations
• Keep out of reach of children
• Do not use after expiration date
• Dispose of unused medication properly through take-back programs

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment recommendations. Dosage and administration should be determined by a physician based on individual patient factors. Never self-medicate with antibiotics. Inappropriate use may lead to antibiotic resistance and treatment failure. Report any adverse reactions to healthcare provider immediately.

Reviews

“Co-amoxiclav has been our department’s workhorse antibiotic for moderate to severe community-acquired pneumonia. The addition of clavulanic acid significantly improves coverage against beta-lactamase producing H. influenzae and M. catarrhalis. We’ve observed clinical success rates exceeding 90% in compliant patients.” - Dr. Eleanor Vance, Infectious Disease Specialist

“After trying multiple antibiotics for recurrent sinusitis, co-amoxiclav provided complete resolution within 5 days. The twice-daily dosing improved adherence compared to previous regimens. Mild gastrointestinal discomfort was manageable with food co-administration.” - Clinical trial patient, Study NCT02831049

“Our microbiology lab consistently reports excellent susceptibility patterns for co-amoxiclav against common respiratory pathogens. The resistance rates remain below 5% for most community-acquired strains, making it a reliable empirical choice.” - Professor Michael Torres, Clinical Microbiologist

“The 875/125 formulation has proven particularly effective in diabetic foot infections where mixed flora including anaerobes are common. We combine it with surgical debridement for optimal outcomes.” - Dr. Sarah Chen, Podiatric Surgeon