Augmentin

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What Augmentin is for

Augmentin combines amoxicillin (a broad-spectrum aminopenicillin) with clavulanic acid (an irreversible beta-lactamase inhibitor). The combination retains amoxicillin’s gram-positive and selected gram-negative coverage while adding activity against beta-lactamase-producing strains of Staphylococcus aureus (methicillin-sensitive only), Haemophilus influenzae, Moraxella catarrhalis, Klebsiella, anaerobes including Bacteroides fragilis, and many Escherichia coli. Common indications:

• Acute bacterial sinusitis — preferred when symptoms are severe, persistent > 10 days, or worsening after initial improvement.
• Acute otitis media — second-line after amoxicillin alone, or first-line when high beta-lactamase prevalence is expected.
• Community-acquired pneumonia (CAP) — typically combined with a macrolide for atypical coverage.
• Acute exacerbations of COPD with purulent sputum and increased dyspnoea.
• Complicated UTI / pyelonephritis in selected cases, guided by local resistance and culture.
• Skin and soft-tissue infections including animal-bite and human-bite prophylaxis (covers Pasteurella multocida, Eikenella corrodens, oral anaerobes).
• Selected bacterial GI infections in traveller’s context — not first-line for routine traveller’s diarrhoea (azithromycin or a fluoroquinolone are preferred), but useful for documented sensitive pathogens.
• Dental abscess / odontogenic infection when penicillin-V monotherapy is inadequate.

How Augmentin works

Amoxicilline binds penicillin-binding proteins (PBPs) in the bacterial cell wall, disrupting peptidoglycan cross-linking and triggering cell lysis — a bactericidal effect. Clavulanic acid has minimal antibacterial activity of its own; it is a “suicide substrate” that irreversibly binds bacterial beta-lactamase enzymes, preventing them from hydrolysing amoxicillin’s beta-lactam ring. The 4:1 amoxicillin-to-clavulanate ratio in the 375 mg tablet (250 mg + 125 mg) is the original GSK formulation; modern higher-dose tablets (625 mg, 1 g) use 7:1 or higher ratios to reduce GI side effects from clavulanate while maintaining beta-lactamase coverage.

Dosering

Bijwerkingen

• Common (1–10%) — diarrhoea (often clavulanate-driven), nausea, vomiting, vaginal candidiasis, mild rash.
• Maculopapular rash — particularly in patients incubating Epstein-Barr virus (~90 % rash rate during infectious mononucleosis). Not a true penicillin allergy.
• Antibiotic-associated diarrhoea — mild self-limiting in most; Clostridioides difficile infection in a minority (especially older patients, hospitalised, or PPI co-use).
• Cholestatic hepatitis — see red-box at top of page.
• Anaphylaxis / urticaria — true IgE-mediated penicillin allergy in roughly 1 in 5,000–10,000 courses.
• Stevens-Johnson syndrome / TEN — rare.

Geneesmiddelinteracties

• Methotrexaat — penicillins reduce renal clearance; risk of methotrexate toxicity (myelosuppression, mucositis). Monitor levels closely or avoid combination.
• Allopurinol — increased risk of maculopapular rash. Mechanism unclear.
• Probenecide — reduces renal tubular secretion of amoxicillin → higher and prolonged amoxicillin levels. Sometimes used deliberately in severe infections.
• Warfarine — case reports of INR increase with broad-spectrum antibiotics due to gut-flora vitamin-K reduction. Monitor INR during a course.
• Orale anticonceptiva — historically claimed but largely disproven for typical courses. Use additional barrier contraception only during prolonged courses or persistent diarrhoea/vomiting.
• Live oral typhoid vaccine — antibiotics may inactivate. Separate by > 3 days.

Contraindications and cautions

• Prior co-amoxiclav-associated jaundice or hepatic dysfunction — absolute lifelong contraindication.
• Penicillin allergy — true IgE-mediated reactions are an absolute contraindication. Approximately 5–10 % cross-reactivity with cephalosporins (mainly first-generation); negligible with later-generation cephalosporins and carbapenems.
• Infectious mononucleosis (EBV) — avoid; high rash rate.
• Ernstige nierfunctiestoornis — dose-adjust as above.
• Zwangerschap — generally considered safe; widely used.
• Borstvoeding — compatible; transfer in milk is small.

Opslag

Store below 25 °C in original blister, away from moisture and direct sunlight. Keep out of reach of children. Do not use after expiry — beta-lactam ring degrades and antibacterial activity falls.

Veelgestelde vragen

Is Augmentin the right antibiotic for traveller’s diarrhoea?

Usually no. First-line empirical antibiotics for moderate-severe traveller’s diarrhoea are single-dose azithromycin 1 g (preferred for South / Southeast Asia given Campylobacter resistance to fluoroquinolones) or ciprofloxacin 500 mg twice daily for 1–3 days (preferred for Latin America, Africa). Augmentin can be used for documented bacterial GI infections sensitive to amoxicillin-clavulanate, or in patients with penicillin-non-allergic histories who cannot take macrolides or fluoroquinolones.

What is the difference between Augmentin 375 mg, 625 mg, and 1 g tablets?

All contain the same two ingredients (amoxicillin + clavulanate) but at different doses and ratios. The 375 mg tablet has 250 mg amoxicillin + 125 mg clavulanate (4:1). The 625 mg tablet has 500 mg amoxicillin + 125 mg clavulanate (4:1). The 1 g tablet has 875 mg amoxicillin + 125 mg clavulanate (7:1) — designed to deliver more amoxicillin without increasing clavulanate-related GI side effects. The 1 g BID schedule is increasingly preferred for sinusitis, lower respiratory infections, and CAP.

Can I drink alcohol while taking Augmentin?

Augmentin does not have a disulfiram-like reaction with alcohol (unlike metronidazole or tinidazole). However, if you are unwell with the underlying infection, alcohol can worsen dehydration and GI side effects. Light-to-moderate alcohol during a 5–7-day course is not specifically dangerous, but is generally not recommended while you are recovering.

Why does Augmentin cause more diarrhoea than amoxicillin alone?

The clavulanate component disrupts gut motility and the colonic microbiome more than amoxicillin alone. This is why higher-amoxicillin / fixed-clavulanate ratios (7:1 in the 1 g tablet) and taking the dose with food were developed — both reduce diarrhoea without losing beta-lactamase coverage.

What should I do if I develop yellow skin or dark urine after a course?

Stop the antibiotic if still ongoing and seek medical attention promptly. Cholestatic hepatitis from co-amoxiclav characteristically appears 1–6 weeks na the course is finished, with jaundice, pruritus, dark urine, and pale stool. Most cases resolve over weeks to a few months. A documented episode is an absolute lifelong contraindication to re-exposure.

Is the rash on amoxicillin a true penicillin allergy?

Not always. A maculopapular rash appearing 5–10 days into a course of amoxicillin or co-amoxiclav, particularly in adolescents and young adults, often reflects underlying Epstein-Barr virus infection (mononucleosis) — not true IgE-mediated penicillin allergy. Urticaria, anaphylaxis, angio-oedema, or rash within minutes-to-hours of a dose are different and should be treated as true allergy until proven otherwise. If unsure, seek formal allergy assessment before re-exposure.

Can I take Augmentin in pregnancy?

Yes. Co-amoxiclav has been used widely throughout pregnancy and is generally considered safe (no significant teratogenic signal). Note: in preterm-pre-labour rupture-of-membranes (PPROM), the ORACLE-II trial signal of increased neonatal necrotising enterocolitis means erythromycin is preferred over co-amoxiclav for that specific indication.

Wat als ik een dosis vergeet?

Take the missed dose as soon as you remember, with food, unless it is almost time for the next dose — in which case skip the missed one. Do not double up. Aim for an even spacing across the day (8-hourly for TID, 12-hourly for BID) for steady gut and tissue levels.

Can I stop the course early once I feel better?

For most indications, complete the prescribed course. Stopping early can leave residual partially-treated bacteria with selection pressure favouring resistant clones. Some recent evidence supports shorter courses (e.g. 5 days for uncomplicated CAP), but this should be a clinician decision based on the specific infection — not a default for all uses.

Does Augmentin cover MRSA?

No. Co-amoxiclav covers methicillin-sensitive Staph aureus (MSSA) but not methicillin-resistant strains (MRSA). For suspected or confirmed MRSA, alternative agents (clindamycin, doxycycline, trimethoprim-sulfamethoxazole, vancomycin, linezolid) are needed depending on site and severity.

How does Augmentin compare with Bactrim or doxycycline for skin infections?

Augmentin covers MSSA, streptococci, anaerobes, and bite-wound flora well — preferred for animal-bite and human-bite prophylaxis. Doxycycline (Cendox) and trimethoprim-sulfamethoxazole cover MRSA but not anaerobes or Pasteurella reliably — preferred when MRSA is suspected. Cellulitis without bite or abscess is typically streptococcal — flucloxacillin or oral cephalexin is often adequate. Choice depends on site, suspected pathogen, and local resistance.

Other Traveller’s Diarrhoea & Antibiotic Options

• Althrocin (erythromycin 250/500 mg) — alternative for Campylobacter / atypical pneumonia
• Cendox (doxycycline 100 mg) — broad-spectrum, MRSA + Lyme + Pasteurella coverage
• Nizonide (nitazoxanide 200/500 mg) — for protozoal causes of diarrhoea
• Medical Emergency Kit — multi-drug travel pack
• Cipmox (amoxicillin 250/500 mg) — without clavulanate, simpler indications
• Ciplox (ciprofloxacin 250/500 mg) — fluoroquinolone option

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