Amoxiclav is a combination antibiotic. Its spectrum of action is quite wide. Is Amoxiclav antiviral? He does not have such an impact, so the answer to the question will be negative. The medicine can be used for diseases of viral etiology only in cases when a secondary infectious disease of bacterial origin has arisen against their background.
Composition and form of release
What is the composition of Amoxiclav tablets? This antibiotic is made in the form of pills, coated with a special coating, containing basic substances. This is amoxicillin in a dosage of 875, 500 or 250 mg and clavulanic acid in a volume of 125 mg. In addition, the Amoxiclav preparation contains some additional components: crospovidone, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, talc, microcrystalline cellulose. Tablets are packaged in blisters and bottles of dark glass.
In addition to tablets, the drug is available in powder form for the manufacture of a suspension. The latter is intended for oral administration. In 5 ml of the finished medicine, the active substances are present in the ratios of 125 mg / 31.25 mg, 250 mg / 62.5 mg, 400 mg / 57 mg. Excipients in the composition of the Amoxiclav preparation in suspension are: citric acid, sodium citrate, MCC and carmellose sodium, xanthan gum, colloidal silicon dioxide, wild cherry flavoring, lemon flavoring, sodium saccharin, mannitol. The powder is packaged in dark glass bottles.
Another dosage form of this medication is a powder for the manufacture of an injection solution containing the main components in the proportions of 1000 mg / 200 mg, 500 mg / 100 mg.
Pharmacological properties
What is the group of Amoxiclav? The antibacterial medication is a semi-synthetic penicillin that acts on many gram-positive and gram-negative microorganisms. This medication suppresses the biological synthesis of peptidoglycan - a substance that is present in the structure of the bacterial cell membrane. A decrease in the production of peptidoglycan causes a decrease in the strength of the cell walls, which subsequently provokes the lysis and destruction of pathogenic microorganisms.
At the same time, amoxicillin is sensitive to the effects of beta-lactamases, which destroy it. As a result, the spectrum of antibacterial activity of this substance does not include pathogens synthesizing this substance. Clavulanic acid is a substance that inhibits the production of beta-lactamases. Its structure is similar to that of penicillic acid.
This component of the Amoxiclav drug has the ability to inactivate numerous beta-lactamases, which are highly resistant to penicillins and cephalosporins. The relative effectiveness of the substance with respect to plasmid beta-lactamases, which in most cases determine the resistance of pathogenic bacteria to antibiotics, is also proved.
Despite this, the substance is not able to act on type I beta-lactamases chromosomal, and this means that they are not neutralized by clavulanic acid. The presence of this substance in the composition of the Amoxiclav medical device allows preventing the destruction of amoxicillin and significantly expanding the range of functionality of this antibacterial substance.
What infections does the drug kill?
Clinical in vitro studies have shown high sensitivity to the effects of the Amoxiclav drug of the following pathogens:
- Gram-negative anaerobic organisms: Bacteroides fragilis, Fusobacterium nucleatum, Prevotella, Porphyromonas, Capnocytophaga, Fusobacterium, Eikenella corrodens.
- Gram-positive anaerobic bacteria: Peptostreptococcus magnus, Peptococcus niger, Peptostreptococcus, Peptostreptococcus micros, Clostridium.
- Gram-negative aerobic bacteria: Moraxella catarrhalis, Vibrio cholerae, Haemophilus influenza, Pasteurella multocida, Neisseria, Helicobacter pylori.
- Gram-positive aerobic bacteria: coagulase-negative staphylococci (showing sensitivity to methicillin), Streptococcus agalactiae, Bacillus anthracis, Streptococcus pyogenes and other streptococci beta-hemolytic category, Listeria monocytogenes, Nocardiaecisococ.
- Other pathogens: Treponema pallidum, Borrelia, Leptospira icterohaemorrhagiae. We will tell about indications of the Amoxiclav preparation below.
What bacteria are resistant to the drug?
Acquired resistance to the active substances of the drug "Amoxiclav" characterized by the following bacteria:
- Gram-positive aerobic: Streptococcus pneumoniae, streptococcus class Viridans, Enterococcus faecium, pathogens of the genus Corynebacterium.
- Gram-negative aerobic: Proteus mirabilis, Shigella, Klebsiella oxytoca, Klebsiella, Escherichia coli and vulgaris.
The natural resistance to the combination of clavulanic acid and amoxicillin is distinguished by: Yersinia enterocolitica, Acinetobacter, Stenotrophomonas maltophilia, Citrobacter freundii, Enterobacter, Pseudomonas, Serratia, Hafnia alvei, Providencia, Legionella pneumophila, Chlamydophi morphophylla psma.
Pharmacokinetic indicators
In accordance with the instructions for use with the drug "Amoxiclav", the main pharmacokinetic values of the active substances of this medicinal product are largely identical. Both active components demonstrate high solubility in aqueous solutions having a physiological pH, and after oral administration of the drug are rapidly absorbed from the cavities of the digestive tract.
The degree of absorption of a combination of active substances is considered the most optimal after taking the medicine before eating. After oral administration of Amoxiclav, the availability of active substances in the body reaches 70 percent.
The combination of clavulanic acid + amoxicillin is characterized by a high level of distribution in various organ systems, tissues and body fluids (including in the lungs, muscle, bone and adipose tissues, abdominal organs, interstitial, peritoneal, synovial and pleural fluids, sputum, bile, pus, urine and skin integument). The active components moderately bind to plasma proteins: amoxicillin in a volume of 18% and clavulanic acid in a volume of 25% of the accepted dosage. The distribution level is approximately 0.3-0.4 l / kg (amoxicillin) and 0.2 l / kg (clavulanic acid). These substances are not able to cross the blood-brain barrier, the exception in this case is inflammation of the meninges.
Like many penicillins, amoxicillin passes into breast milk during lactation. In it, in trace concentrations, clavulanic acid is detected. The active components of the drug also penetrate the placenta.
What else does the instruction for use of the Amoxiclav preparation tell us? About 10–25% of the initial dosage of amoxicillin is excreted in the urine as penicilloic acid, which is pharmacologically inactive. Clavulanic acid undergoes an intensive metabolic process with the formation of substances excreted through the kidneys, gastrointestinal tract, as well as when air is exhaled (passes into carbon dioxide).
According to the instructions of the Amoxiclav preparation, amoxicillin is excreted from the body mainly through renal filtration, clavulanic acid - through the kidneys and other mechanisms. After oral administration, approximately 60–75% of amoxicillin and 40–70% of clavulanic acid can be excreted in the urine for six hours unchanged. On average, the half-life of the active elements of the drug is one hour, and the total average clearance is approximately 25 l / h. In patients with renal dysfunction, clearance decreases in proportion to a decrease in renal function.
Indications for appointment
According to the information given in the instructions for use, the drug "Amoxiclav" is prescribed for the treatment of infectious inflammatory pathologies provoked by microorganisms sensitive to it. The medication is indicated for use:
- with gynecological infections;
- diseases of the ENT organs and respiratory canals: sinusitis (acute, chronic type), pharyngitis, otitis media, tonsillitis, pharyngeal abscess;
- infections of bone and connective tissue;
- infectious pathologies of the lower parts of the respiratory organs, including chronic bronchitis, inflammation of the acute bronchial tubes with bacterial superinfection, pneumonia;
- urinary tract diseases;
- pathologies of soft tissues and skin, including insect and animal bites; biliary tract infections;
- infectious damage to the structures of the peritoneum;
- infections transmitted through sexual contact - mild chancre, gonorrhea.
It is also used to prevent the development of infectious diseases after surgical procedures.
List of contraindications
With indications for the use of the drug "Amoxiclav" sorted out. A pharmacological agent is not prescribed for hepatitis and cholestatic jaundice due to the use of antibiotics from the penicillin class. In addition, this medication is contraindicated:
- in the presence of sensitivity to clavulanic acid, penicillin preparations, amoxicillin, other substances present in its composition;
- lymphocytic leukemia;
- infectious mononucleosis.
Use with caution
We continue the description. The drug "Amoxiclav" is recommended for use with caution in case of such pathological phenomena:
- history of pseudomembranous colitis;
- liver failure;
- severe renal impairment.
The possibility of prescribing this antibiotic during pregnancy and the lactation process should be decided with the doctor individually.
Instructions for use
The rules for taking the medication and the duration of therapeutic measures are determined depending on the severity of the existing infectious pathology, the age of the patient, kidney function and body weight. In the form of tablets and suspensions, Amoxiclav should be drunk with food. This can significantly reduce the likelihood of negative reactions to the digestive system. The average course of therapy is 5-14 days. Longer treatment is possible after a second medical examination. This confirms the instructions for use for the drug "Amoxiclav".
Dosage regimen
At the age of less than 12 years, the medication is prescribed in a dosage of 40 mg / kg per day (the dose should be divided into three doses). The drug in this case is prescribed in the form of a suspension. For children weighing more than 40 kg, the dosages used for adult patients are shown.
The following medication regimens are possible for adult patients with moderate to mild illness:
- Every 8 hours, 1 tablet (250 + 125 mg).
- 1 tablet after 12 hours (500 + 125 mg).
With a severe degree of the pathological process and with respiratory diseases, it is necessary to take 1 tablet every 8 hours in doses of 500 + 125 mg or 875 + 125 mg after 12 hours. In case of odontogenic infections, the use of 1 tablet in doses of 250 + 125 mg (interval - 8 hours) or 500 + 125 mg (interval - 12 hours) is indicated for 5 days. So it is said in the instructions for the drug "Amoxiclav."
For children up to 3 months, the medication is prescribed in the form of a suspension of 30 mg / kg of amoxicillin per day (every 12 hours). To properly comply with the child’s dosage of the drug, you must use a special pipette that comes with the package.
Daily dose for children after 3 months:
- with mild to moderate severity of the disease - from 20 mg / kg per day;
- severe course of the disease and treatment of pathologies, lower respiratory canals, sinusitis and otitis media - up to 40 mg / kg per day.
It must be borne in mind that when choosing the dosage of the drug in question for the child, one should not rely on age, but on the severity of the course of the disease and on body weight. Very carefully you need to use the drug "Amoxiclav".
An antibiotic in the form of a solution for injection is administered intravenously. For children after 3 months, the dose is calculated as follows:
- with a body weight of less than 4 kg, the drug is administered at a dose of 30 mg / kg (after 12 hours);
- if the weight is more than 4 kg - 30 mg / kg (after 8 hours).
In newborns up to 3 months, the injection solution is administered slowly, for at least 40 minutes. For children whose weight is not more than 40 kg, the dosage is selected taking into account body weight. For children from 3 months to 12 years of age, the medication should be administered at a dose of 30 mg / kg every 8 hours, and in case of severe infection, every 6 hours. For pediatric patients with a diagnosed impaired renal function, dose adjustment may be required.
For children after 12 years of age (weight - more than 40 kg) and adult patients, Amoxiclav in the form of an injection solution is administered at a dose of 1200 mg every 8 hours or every 6 hours in case of acute infectious disease.
The drug can also be prescribed for surgical interventions in prophylactic doses (1200 mg with anesthesia in cases if the operation lasts less than 2 hours). With longer interventions, the patient should receive medication in the same dose up to 4 times a day.
Side effects of the drug "Amoxiclav"
The use of a medication in the treatment of infectious pathologies of a drug can lead to the development of the following adverse reactions:
- Hemopoietic system: eosinophilia, thrombocytopenia, decreased hemoglobin, leukopenia, agranulocytosis.
- Digestive system: flatulence, diarrhea, gastritis, nausea, dyspeptic disorders, stomatitis, glossitis, enterocolitis, anorexia, vomiting.
- CNS: anxiety, inappropriate behavior, excessive agitation, convulsive syndrome, confused consciousness, hyperactivity, insomnia, dizziness, headache.
- Skin: swelling, urticaria, rash, in rare cases - erythema multiforme, exfoliative dermatitis, epidermal necrolysis of a toxic type.
- Urinary system: hematuria, interstitial nephritis.
In addition to the above side effects, superinfection (including candidiasis) may occur. In most cases, such reactions of the body are transient and mild.
Overdose
There is no information that Amoxiclav provokes life-threatening conditions when taken in high doses. Most often, this condition is manifested by pathological symptoms such as disturbed electrolyte balance and gastrointestinal dysfunction (diarrhea, vomiting, abdominal pain). Sometimes taking the medication can lead to crystalluria, and subsequently to renal failure.
In patients with renal dysfunction or when taking medication in high concentrations, convulsive seizures may develop. In case of an overdose, the patient should be under the supervision of a specialist who, if necessary, will recommend symptomatic treatment.
If the drug was taken no more than 4 hours ago, it is advisable to wash the stomach and take intestinal sorbents to reduce its absorption into the blood. The active elements of this drug are well excreted by hemodialysis.
Special recommendations
Taking the original drug Amoxiclav with food reduces the likelihood of negative effects on the digestive system. With a course of treatment, it is necessary to control the work of the liver, kidneys and the hematopoiesis system. Against the background of renal dysfunction, it is recommended that the dosage regimen be corrected or the interval between doses of the drug is extended.
If during treatment the patient is diagnosed with adverse effects from the central nervous system, it is recommended to refrain from driving and performing work that requires a high speed of mental and motor reactions.
Use during pregnancy and lactation
When conducting experiments on animals, the negative effect of this medication on the embryonic development of the fetus was not confirmed. Nevertheless, it is known that the prophylactic use of the drug increases the risk of developing necrotizing enterocolitis during the neonatal period. During pregnancy, as well as during lactation, the use of Amoxiclav is allowed only if specialists evaluate the benefit / risk ratio.
The main elements of the drug in small doses are determined in breast milk. In infants, sensitization, diarrhea, and candidiasis of the mucous membranes of the oral cavity may occur, therefore, if it is necessary to take the drug, it is advisable to stop breastfeeding.
Other drug compatibility
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The use of the drug "Amoxiclav" with "Allopurinol" can cause the development of allergic reactions on the skin. It is not recommended to use the medication in conjunction with Disulfiram. The combination of the main substances of the drug reduces the effectiveness of drugs whose metabolism promotes the formation of para-aminobenzoic acid. Co-administration with ethinyl estradiol increases the risk of breakthrough bleeding.
What else can be said about the compatibility of Amoxiclav with other drugs? If necessary, combined use with anticoagulants requires systematic monitoring of prothrombin time or INR. In this case, dose adjustment of anticoagulants may be required. Joint administration with "Rifampicin" can lead to a mutual weakening of the antibacterial effect. It is not recommended to use the drug in combination with tetracyclines, macrolides and sulfonamides in connection with a likely decrease in its effectiveness. How Amoxiclav interacts with other drugs can be checked with your doctor.
Taking the drug leads to a decrease in the effect of taking oral contraceptives.
Medication price
The cost of the drug "Amoxiclav" in tablet form (875 mg / 125 mg) is approximately 400-440 rubles. Tablets with a dosage of 500 mg / 125 mg substances cost 330-400 rubles, a dose of 250 mg / 125 mg - 160-240 rubles. Powder for the manufacture of a suspension (dose - 400 mg / 57 mg) is sold at a price of 160-270 rubles, a dose of 250 mg / 62.5 mg - 210-300 rubles, a dose of 125 mg / 31.25 mg - 100-120 rubles. Powder for the manufacture of an injection solution in a dosage of 1000 mg / 200 mg costs about 670-860 rubles, 500 mg / 100 mg - 460-490 rubles.
Analogs for the main substance
Analogues of the drug "Amoxiclav" are:
- "Bactoclav";
- Klamosar
- "Panklav";
- Arlet
- "Medoclav";
- “Augmentin”;
- "Liklav";
- "Rapiclava";
- "Ecoclave";
- Fibell;
- Amoxivan
- Amovikomb.
The above analogues have an absolutely identical composition and characteristics, so they can be used for the same diseases as the tool we are describing.
One of the popular analogues is Augmentin. This is an antibiotic with a wide spectrum of action, it also contains amoxicillin and clavulanic acid. It suppresses a large number of gram-positive and gram-negative microorganisms and has a bactericidal effect. Clavulanic acid, which is present in the composition of the tablets, protects amoxicillin from the fatal destruction of beta-lactamases produced by microorganisms, thereby contributing to the expansion of the antibacterial properties of the drug.
Thanks to this component, Augmentin can be detrimental to bacteria that are highly resistant to the penicillin group of drugs and cephalosporins. Dosages should be determined only by the attending physician, especially when it comes to young children.
The minimum course of antibiotic therapy with this drug is five days. Therapy should not continue for more than two weeks without reviewing the clinical situation. In order for absorption to be optimal and reduce the likelihood of side effects from the digestive tract, Augmentin is recommended to be taken at the beginning of a meal.
Analogs in action
The following drugs act as analogues of this medication according to the mechanism of therapeutic action:
- Libacyl is an antibiotic that contains a combination of polysynthetic aminopenicillin - ampicillin and a beta-lactamase inhibiting substance - sulbactam. The bactericidal effect of the main element is due to binding to bacterial transpeptidases involved in the synthesis of glycopeptides, the structural components of the cell walls of pathogens. Ampicillin destroys beta-lactamases - enzymes produced by microorganisms, which significantly limits the spectrum of action of this substance. Sulbactam from the composition of the drug is a derivative of the penicillin core. It does not have clinically significant activity, but inhibits beta-lactamases, therefore its presence in the composition of the drug significantly increases its effectiveness.
- "Timentin" is another analogue of the drug "Amoxiclav." This is a combination drug based on carboxypenicillin - sodium ticarcillin and potassium clavulanate with a wide spectrum of activity for empirical parenteral treatment of a number of infectious diseases. It can be used in the treatment of sepsis, septicemia, bacteremia, intraabdominal infections, including peritonitis, postoperative infections, gynecological pathologies, including endometritis, infectious diseases of bones and joints, respiratory tract, kidneys, etc.
- "Santaz" is an antibiotic based on piperacillin and tazobactam. Piperacillin is a semi-synthetic bactericidal substance of wide action, which is active against many pathogens of infectious diseases. Piperacillin inhibits the synthesis of cell membranes of the walls of the pathogen. Tazobactam is a sulfonate derivative of triazolmethylpenicillanic acid, a potent inhibitor of beta-lactamases that provoke resistance to cephalosporins and penicillins. The presence of tazobactam in this medicament enhances antimicrobial efficacy and expands the range of piperacillin due to the inclusion of bacteria that form beta-lactamases.
Reviews about the drug "Amoxiclav"
In most cases, patients and doctors leave positive reviews about this drug. Doctors note that this medication is quite effective in the treatment of pathologies of the respiratory, urinary, reproductive systems, skin infections, etc. According to doctors, Amoxiclav is a modern and high-quality antibiotic that can be prescribed for almost any infection.
Patients who took this remedy characterize it as an inexpensive affordable drug, very effective. It can be used not only for adult patients, but also for children, and from a very early age.
Some negative reviews about the drug are due to side effects from taking it. Among them, the most frequently observed imbalance in the intestinal microflora, which led to unpleasant symptoms in the form of nausea, heartburn, increased gas formation. Some small patients experienced short-term nausea. Violations of the functionality of the nervous system are not described in the reviews, so we can conclude that they appear extremely rarely. As a rule, adverse reactions were mild and did not require discontinuation of the drug.
Children "Amoxiclav" tolerate well, which is also confirmed by the mass of positive reviews. It is often prescribed by pediatricians even in severe infectious diseases in babies.