Usage
Amoxycillin + Lactobacillus acidophilus + Potassium clavulanate is prescribed for a variety of bacterial infections, including those of the ears, nose, throat, lungs (including pneumonia and bronchitis), sinuses, skin, urinary tract, bones, joints, and soft tissues. It may also be used to treat infectious diarrhea and, in combination with other medications, for H. pylori infections in the stomach. It is ineffective against viral infections like the common cold and flu. Its pharmacological classifications are antibiotic and probiotic.
Amoxycillin interferes with bacterial cell wall synthesis, ultimately leading to bacterial death. Potassium clavulanate is a beta-lactamase inhibitor. It enhances amoxycillin’s effectiveness by inhibiting beta-lactamase, an enzyme produced by some bacteria that can make them resistant to antibiotics. Lactobacillus acidophilus is a probiotic that helps restore the gut’s healthy bacteria, potentially minimizing antibiotic-associated diarrhea caused by disruption of the gut flora.
Alternate Names
This combination does not have an official international nonproprietary name (INN). Some regional or descriptive names may include “Amoxicillin-clavulanate-probiotic” or “Amoxicillin-clavulanate with Lactobacillus.” Brand names include Pinoclav-CL LB, App-MOXCV 625 lb, Gymox CV, and Acv-LB. Many others exist. Please note this is not an exhaustive list.
How It Works
Pharmacodynamics: Amoxycillin exerts a bactericidal effect by inhibiting the synthesis of bacterial cell walls, leading to cell lysis and death. Potassium clavulanate has no significant antibacterial activity on its own but protects amoxycillin by inactivating bacterial beta-lactamases. Lactobacillus acidophilus exerts its probiotic effects by competing with pathogenic bacteria for resources and adhesion sites in the gut. It also produces lactic acid, which creates an unfavorable environment for some harmful bacteria.
Pharmacokinetics:
- Absorption: Amoxycillin is well-absorbed orally and is stable in the presence of gastric acid. Taking it at the beginning of a meal may enhance absorption. Absorption of clavulanate is also good after oral administration.
- Metabolism: Amoxycillin is primarily excreted unchanged in the urine. A small fraction is metabolized to inactive penicilloic acid. Clavulanate undergoes extensive metabolism, with only a small amount excreted unchanged in urine.
- Elimination: Primarily renal excretion for both amoxycillin and clavulanate. Dose adjustments are necessary for patients with renal impairment.
Mode of Action: Amoxycillin inhibits transpeptidases and carboxypeptidases, enzymes crucial for bacterial cell wall synthesis. Clavulanate irreversibly binds to bacterial beta-lactamases, preventing them from degrading amoxycillin.
Dosage
Standard Dosage
Special Cases:
- Elderly Patients: Dosage adjustments may be needed based on renal function.
- Patients with Renal Impairment: Dose reduction and/or increased dosing intervals are required. Avoid the 875/125 mg tablet formulation in patients with creatinine clearance less than 30 mL/min.
- Patients with Hepatic Dysfunction: Use with caution and monitor liver function.
- Patients with Comorbid Conditions: Consider potential drug interactions with other medications the patient may be taking.
Clinical Use Cases
Specific dosages for clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations should be determined on a case-by-case basis by the treating physician, considering the patient’s condition, the infection’s severity, and potential drug interactions. General guidelines provided in the Standard Dosage section apply, with adjustments as needed.
Dosage Adjustments
Dose modifications are essential for patients with renal or hepatic impairment. Consult specific guidelines and consider factors like creatinine clearance and liver function tests.
Side Effects
Common Side Effects:
Diarrhea, nausea, vomiting, abdominal pain, skin rash, itching, bloating, gas, flatulence.
Rare but Serious Side Effects:
- Clostridium difficile-associated diarrhea (CDAD).
- Allergic reactions (anaphylaxis, angioedema, serum sickness-like reaction).
- Hepatotoxicity (cholestatic jaundice, hepatitis).
- Blood dyscrasias (leukopenia, thrombocytopenia, agranulocytosis).
Long-Term Effects: With prolonged use, potential risks include the development of antibiotic resistance, C. difficile infection, and vitamin K deficiency.
Contraindications
- Hypersensitivity to amoxycillin, clavulanate, other penicillins, or any component of the formulation.
- History of cholestatic jaundice or hepatic dysfunction associated with amoxycillin-clavulanate use.
Drug Interactions
- Allopurinol: Increased risk of skin rash.
- Anticoagulants (e.g., warfarin): May potentiate anticoagulant effects.
- Oral contraceptives: May reduce efficacy.
- Methotrexate: Increased methotrexate toxicity.
- Probenecid: Increases amoxycillin levels.
Pregnancy and Breastfeeding
Amoxycillin-clavulanate is generally considered safe to use during pregnancy if medically necessary. It is excreted in breast milk, and while generally considered compatible with breastfeeding, infants should be monitored for diarrhea, rash, and irritability. Discuss with the patient to weigh the benefits of breastfeeding against potential risks to the infant.
Drug Profile Summary
- Mechanism of Action: Amoxycillin inhibits bacterial cell wall synthesis; clavulanate inhibits beta-lactamase; Lactobacillus acidophilus promotes a healthy gut flora.
- Side Effects: Common: diarrhea, nausea, rash. Serious: allergic reactions, hepatotoxicity, CDAD.
- Contraindications: Hypersensitivity to penicillins, history of cholestatic jaundice/hepatic dysfunction with amoxycillin-clavulanate.
- Drug Interactions: Allopurinol, anticoagulants, oral contraceptives, methotrexate, probenecid.
- Pregnancy & Breastfeeding: Generally considered safe if medically indicated; monitor infant if breastfeeding.
- Dosage: Varies depending on infection; see detailed section above.
- Monitoring Parameters: Renal and liver function, signs of allergic reactions, signs and symptoms of infection.
Popular Combinations
This combination itself is sometimes considered a popular combination. However, combining amoxicillin-clavulanate with other antibiotics is not routinely recommended due to the risk of adverse effects and the development of antibiotic resistance. The probiotic component is intended to mitigate gastrointestinal side effects associated with antibiotics.
Precautions
- Assess for penicillin allergy before administration.
- Monitor renal and hepatic function, especially with pre-existing conditions.
- Caution in patients with mononucleosis due to increased risk of rash.
- Avoid alcohol during treatment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Amoxycillin + Lactobacillus Acidophilus + Potassium Clavulanate?
A: The dosage depends on various factors, including the patient’s age, weight, the infection’s severity, and renal function. Consult the detailed Dosage section above for more information.
Q2: Can this medication be used in patients with penicillin allergy?
A: No, it is contraindicated in patients with a known hypersensitivity to penicillins.
Q3: What are the common side effects?
A: Common side effects include diarrhea, nausea, vomiting, abdominal pain, and skin rash.
Q4: What are the serious side effects?
A: Serious side effects can include C. difficile infection, severe allergic reactions, liver problems, and blood disorders. Seek immediate medical attention if these occur.
Q5: Can I take this medication with alcohol?
A: Alcohol should be avoided while taking this medication.
Q6: Can this medication be used during pregnancy and breastfeeding?
A: It can be used if medically necessary. However, it is important to discuss the risks and benefits with a physician. It is excreted in breastmilk, and while generally considered compatible with breastfeeding, infants should be monitored for side effects.
Q7: How does the lactobacillus acidophilus component affect the medication’s use?
A: Lactobacillus acidophilus is included to help prevent antibiotic-associated diarrhea, a common side effect of amoxycillin-clavulanate.
Q8: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.
Q9: How long should treatment continue?
A: The duration of treatment varies depending on the infection. It’s crucial to complete the full course of treatment as prescribed, even if symptoms improve, to prevent antibiotic resistance.
Q10: What are the storage recommendations for this medication?
A: Store in a cool, dry place, away from direct sunlight and moisture. Keep out of reach of children. Refer to the specific product’s packaging for detailed storage instructions.
