Co-Amoxiclav

Amoxicillin + clavulanic acid (B-lactamase inhibitor). The B-lactamase inhibitory action of clavulinic acid extends the spectrum of antibacterial activity of amoxicillin.

Uses:
Respiratory tract infections
Genito-urinary tract infections
Intra-abdominal sepsis
Surgical prophylaxis

Contraindications:
Penicillin hypersensitivity

Administration:
• IV: 1.2 g 8 hourly (6 hourly in severe infections)
Reconstitute with 20 ml WFI, given IV over 3–5 min
In renal impairment:

Initial dose of 1.2 g, then:

CC (ml/min)	Dose (g)	Interval (h)
10–20	1.2	12
<10	0.6–1.2	12

How not to use co-amoxiclav:
Do not mix with aminoglycoside in same syringe (will inactivate aminoglycoside)

Adverse effects:
Hypersensitivity
Cholestatic jaundice (usually self-limiting, up to 2–6 weeks after treatment stops)
Bleeding and prothrombin time may be prolonged

Organ failure:
Renal: reduce dose

Renal replacement therapy:
CVVH dialysed dose as in CC 10–20 ml/min, i.e. 1.2 g IV every 12 hours, oral as in normal renal function. HD and PD dialysed dose as in CC <10 ml/min, i.e. IV: 1.2 g stat followed by 600 mg–1.2 g every 12 hours; oral 375–625 mg 8 hourly. Pharmacokinetics of the amoxicillin and clauvulanate are closely matched, probably cleared at similar rates.