Pregnancy and lactation

Pregnancy

Animal studies have not revealed a direct or indirect negative effect of the drug on pregnancy, embryonic / fetal development, childbirth or postpartum development. click here to buy augmentin 875 mg online Limited data on the use of amoxicillin / clavulanic acid by women during pregnancy did not reveal an increased risk of congenital anomalies. In one study in women with premature rupture of the membranes, prophylactic amoxicillin / clavulanic acid combination therapy may be associated with an increased risk of necrotizing enterocolitis in newborns. Medication should be avoided during pregnancy, unless the physician considers it necessary.

Both active substances of the drug pass into breast milk (the effect of clavulanic acid on breast-fed infants is not known). In this regard, there is a likelihood of developing diarrhea or fungal infection of the mucous membranes in children who are breast-feeding, so lactation may need to be stopped. The possibility of sensitization should be taken into account. The combination of amoxicillin / clavulanic acid can be used during breastfeeding only after assessing the benefit / risk by the attending physician.

Hemodialysis patients

1. Dose adjustment based on maximum recommended dose of amoxicillin.
2. Adults: 1 tablet 500 mg / 125 mg every 24 hours.
3. In addition, 1 dose is prescribed during the dialysis session and another dose at the end of the dialysis session (to compensate for the decrease in serum concentrations of amoxicillin and clavulanic acid).
4. Tablets with a dosage of 875 mg / 125 mg should be used only in patients with creatinine clearance> 30 ml / min.

Pharmacodynamics

Amoxicillin is a semi-synthetic broad-spectrum antibiotic with activity against many gram-positive and gram-negative microorganisms. http://www.goodrx.com/augmentin At the same time, amoxicillin is susceptible to destruction by beta-lactamases, and therefore the spectrum of activity of amoxicillin does not extend to the microorganisms that produce this enzyme.

Clavulanic acid, a beta-lactamase inhibitor structurally related to penicillins, has the ability to inactivate a wide range of beta-lactamases found in penicillin and cephalosporin resistant microorganisms. Clavulanic acid is sufficiently effective against plasmid beta-lactamases, which are most often responsible for bacterial resistance, and is less effective against chromosome beta-lactamases of the 1st type, which are not inhibited by clavulanic acid.

The presence of clavulanic acid in the Augmentin ® preparation protects amoxicillin from destruction by enzymes - beta-lactamases, which allows to expand the antibacterial spectrum of amoxicillin.

The following is the in vitro combination activity of amoxicillin with clavulanic acid.

Bacteria commonly susceptible to a combination of amoxicillin with clavulanic acid

Gram-positive aerobes: Bacillus anthracis, Enterococcus faecalis, Listeria monocytogenes, Nocardia asteroides, Streptococcus spp., Incl. Streptococcus pyogenes 1,2, Streptococcus agalactiae 1,2 (other beta hemolytic streptococci) 1,2, Staphylococcus aureus (sensitive to methicillin) 1, Staphylococcus saprophyticus (sensitive to methicillin), coagulase-negative staphylococci (sensitive to).

Gram-positive anaerobes: Clostridium spp., Peptococcus niger, Peptostreptococcus spp., Including Peptostreptococcus magnus, Peptostreptococcus micros.

Gram-negative aerobes: Bordetella pertussis, Haemophilus influenzae 1, Helicobacter pylori, Moraxella cafarrhalis 1, Neisseria gonorrhoeae, Pasteurella multocida, Vibrio cholerae.

Gram-negative anaerobes: Bacteroides spp., Incl. Bacteroides fragilis, Capnocytophaga spp., Eikenella corrodens, Fusobacterium spp., Including Fusobacterium nucleatum, Porphyromonas spp., Prevotella spp.

Other: Borrelia burgdorferi, Leptospira icterohaemorrhagiae, Treponema pallidum.

Bacteria for which acquired resistance to a combination of amoxicillin with clavulanic acid is likely

Gram-negative aerobes: Escherichia coli 1, Klebsiella spp., Incl. Klebsiella oxytoca, Klebsiella pneumoniae 1, Proteus spp., Including Proteus mirabilis, Proteus vulgaris, Salmonella spp., Shigella spp.

Gram-positive aerobes: Corynebacterium spp., Enterococcus faecium, Streptococcus pneumoniae 1,2, streptococcus group Viridans.

Bacteria that are naturally resistant to the combination of amoxicillin with clavulanic acid

Gram-negative aerobes: Acinetobacter spp., Citrobacter freundii, Enterobacter spp., Hafnia alvei, Legionella pneumophila, Morganella morganii, Providencia spp., Pseudomonas spp., Serratia spp., Stenotrophomonas maltophilia, Yersinia enter.

Other: Chlamydia spp., Incl. Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, Mycoplasma spp.

1 For these bacteria, the clinical efficacy of a combination of amoxicillin with clavulanic acid has been demonstrated in clinical trials..

2 Strains of these types of bacteria do not produce beta-lactamase. Sensitivity with amoxicillin monotherapy suggests a similar sensitivity to the combination of amoxicillin with clavulanic acid.