CO-AMOXICLAV
Please note co-amoxiclav is not licensed for the treatment of tuberculosis in the UK.
Co-amoxiclav is not usually recommended for the treatment of MDRTB. When it is used, it should be counted as half a drug in a treatment regimen. It is sometimes recommended in combination with meropenem for its clavulanate content. Co-amoxicalv inhibits the beta-lactamase which destroys meropenem activity. Clavulanate alone is not available for use in the UK.
DOSAGE
[NOTE: Limited data on evidence for dosing in TB. The adult doses are based on those used in the treatment of respiratory tract infections in the BNF no 65, March 2013. The paediatric doses are similarly based on dosing for respiratory tract infections in the latest BNF for children 2012-13].
For all patients over 12 years old:
By intravenous infusion over 3-4 minutes:
· Patients over 12 years old: 1.2g 8 hourly
· Neonates: 30mg/kg every 12 hours
· Children 1 -3 months 30mg/kg every 12 hours
· 3 months – 18 years 30mg/kg every 8 hours
By mouth:
· Patients over 12 years old: 625mg, 8 hourly
· Neonates: 0.25 mL/kg of 125/31 suspension every 8 hours
· Children 1 month- 1 year : 0.25 mL/kg of125/31 suspension every 8 hours
Dose doubled in severe infection
· 1–6 years: 5 mL of125/31 suspension every 8 hours or 0.25 mL/kg of 125/31 suspension every 8 hours
Dose doubled in severe infection
· 6–12 years: 5 mL of 250/62 suspension every 8 hours Or 0.15 mL/kg of 250/62 suspension every 8 hours
Dose doubled in severe infection
In renal failure dose reduction may be necessary. Please discuss with a pharmacist.
PREPARATIONS
Oral: 250/125mg (375mg), 500/125mg (625mg) tablets.
125/31mg, 250/62mg suspension.
Parenteral: 500/100mg, 1000/200mg Powder for solution for injection or infusion.
DRUG LEVEL MONITORING
· Drug levels need not be routinely measured.
ADVERSE EFFECTS
COMMON:
Dermatological: Rash & urticaria (3%).
Gastrointestinal: Nausea & vomiting (1-5%), diarrhoea (9%).
Infective: Candidiasis, particularly oral and vaginal (1%).
SERIOUS:
Dermatological: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis.
Hepatic: Hepatitis, cholestatic jaundice.
Immunological: Anaphylaxis.
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
No common serious drug interactions usually expected.
Anticoagulants: Case reports of increased INR in patients taking acenocoumarol or warfarin and prescribed a course of amoxicillin. Monitor INR.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: To penicillins.
Liver Disease: Previous history of jaundice/hepatic impairment due to co-amoxiclav.
Cautions:
Pregnancy & Breast-feeding
Renal Disease: Use with caution. Reduce dose in severe renal impairment.
Liver Disease: Use with caution. Monitor liver function. Cholestatic jaundice may occur during or shortly after the use of co-amoxiclav. Risk is higher in patients aged >65 years and in men.
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time varies depending on the test and whether it is run locally or sent to an external lab. By contacting laboratories in advance, turnaround time can significantly be reduced.
Co-amoxiclav is not usually recommended for the treatment of MDRTB. When it is used, it should be counted as half a drug in a treatment regimen. It is sometimes recommended in combination with meropenem for its clavulanate content. Co-amoxicalv inhibits the beta-lactamase which destroys meropenem activity. Clavulanate alone is not available for use in the UK.
DOSAGE
[NOTE: Limited data on evidence for dosing in TB. The adult doses are based on those used in the treatment of respiratory tract infections in the BNF no 65, March 2013. The paediatric doses are similarly based on dosing for respiratory tract infections in the latest BNF for children 2012-13].
For all patients over 12 years old:
By intravenous infusion over 3-4 minutes:
· Patients over 12 years old: 1.2g 8 hourly
· Neonates: 30mg/kg every 12 hours
· Children 1 -3 months 30mg/kg every 12 hours
· 3 months – 18 years 30mg/kg every 8 hours
By mouth:
· Patients over 12 years old: 625mg, 8 hourly
· Neonates: 0.25 mL/kg of 125/31 suspension every 8 hours
· Children 1 month- 1 year : 0.25 mL/kg of125/31 suspension every 8 hours
Dose doubled in severe infection
· 1–6 years: 5 mL of125/31 suspension every 8 hours or 0.25 mL/kg of 125/31 suspension every 8 hours
Dose doubled in severe infection
· 6–12 years: 5 mL of 250/62 suspension every 8 hours Or 0.15 mL/kg of 250/62 suspension every 8 hours
Dose doubled in severe infection
In renal failure dose reduction may be necessary. Please discuss with a pharmacist.
PREPARATIONS
Oral: 250/125mg (375mg), 500/125mg (625mg) tablets.
125/31mg, 250/62mg suspension.
Parenteral: 500/100mg, 1000/200mg Powder for solution for injection or infusion.
DRUG LEVEL MONITORING
· Drug levels need not be routinely measured.
ADVERSE EFFECTS
COMMON:
Dermatological: Rash & urticaria (3%).
Gastrointestinal: Nausea & vomiting (1-5%), diarrhoea (9%).
Infective: Candidiasis, particularly oral and vaginal (1%).
SERIOUS:
Dermatological: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis.
Hepatic: Hepatitis, cholestatic jaundice.
Immunological: Anaphylaxis.
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
No common serious drug interactions usually expected.
Anticoagulants: Case reports of increased INR in patients taking acenocoumarol or warfarin and prescribed a course of amoxicillin. Monitor INR.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: To penicillins.
Liver Disease: Previous history of jaundice/hepatic impairment due to co-amoxiclav.
Cautions:
Pregnancy & Breast-feeding
Renal Disease: Use with caution. Reduce dose in severe renal impairment.
Liver Disease: Use with caution. Monitor liver function. Cholestatic jaundice may occur during or shortly after the use of co-amoxiclav. Risk is higher in patients aged >65 years and in men.
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time varies depending on the test and whether it is run locally or sent to an external lab. By contacting laboratories in advance, turnaround time can significantly be reduced.
