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DRUG INTERACTIONS
Drug Interactions:
Probenecid decreases the renal tubular secretion of amoxicillin.
Concurrent use with AUGMENTIN ES-600 Powder for Oral Suspension may result in increased and
prolonged blood levels of amoxicillin. Co-administration of probenecid
cannot be recommended.
Abnormal prolongation of prothrombin time (increased
international normalized ratio [INR]) has been reported rarely in
patients receiving amoxicillin and oral anticoagulants. Appropriate
monitoring should be undertaken when anticoagulants are prescribed
concurrently. Adjustments in the dose of oral anticoagulants may be
necessary to maintain the desired level of anticoagulation.
The concurrent administration of allopurinol and ampicillin
increases substantially the incidence of rashes in patients receiving
both drugs as compared to patients receiving ampicillin alone. It is not
known whether this potentiation of ampicillin rashes is due to
allopurinol or the hyperuricemia present in these patients. There are no
data with AUGMENTIN ES-600 Powder for Oral Suspension and allopurinol administered concurrently.
In common with other broad-spectrum antibiotics, amoxicillin/clavulanate may reduce the efficacy of oral contraceptives.
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OVERDOSAGE
Following overdosage, patients have experienced primarily
gastrointestinal symptoms including stomach and abdominal pain, vomiting, and
diarrhea. Rash, hyperactivity, or drowsiness have also been observed in a small
number of patients.
In the case of overdosage, discontinue AUGMENTIN ES-600 Powder for Oral Suspension, treat symptomatically, and institute supportive measures as required. If the overdosage is very recent and there is no contraindication, an attempt at emesis or other means of removal of drug from the stomach may be performed. A prospective study of 51 pediatric patients at a poison control center suggested that overdosages of less than 250 mg/kg of amoxicillin are not associated with significant clinical symptoms and do not require gastric emptying.4
Interstitial nephritis resulting in oliguric renal failure has been
reported in a small number of patients after overdosage with amoxicillin.
Crystalluria, in some cases leading to renal failure, has also been
reported after amoxicillin overdosage in adult and pediatric patients. In case
of overdosage, adequate fluid intake and diuresis should be maintained to
reduce the risk of amoxicillin crystalluria.
Renal impairment appears to be reversible with cessation of drug
administration. High blood levels may occur more readily in patients with
impaired renal function because of decreased renal clearance of both
amoxicillin and clavulanate. Both amoxicillin and clavulanate are removed from
the circulation by hemodialysis.
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CONTRAINDICATIONS
AUGMENTIN ES-600 Powder for Oral Suspension is contraindicated in patients with a history of allergic reactions to any penicillin. It is also contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with AUGMENTIN.
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REFERENCES
- Clinical and Laboratory Standards Institute (CLSI). Performance Standards
for Antimicrobial Susceptibility Testing – 21st Informational Supplement.
CSLI Document M100-S21. CLSI, 940 West Valley Rd., Suite 1400, Wayne, PA
19087, 2011.
- Clinical and Laboratory Standards Institute (CLSI). Methods for
Antimicrobial Susceptibility Testing of Anaerobic Bacteria – Approved
Standard 7th ed. CSLI Document M11-A7. CLSI, 940 West Valley Rd., Suite
1400, Wayne, PA 19087, 2007.
- Clinical and Laboratory Standards Institute (CLSI). Methods for
Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow
Aerobically; Approved Standard – 8th ed. CLSI Document M07-A8. CLSI, 940
West Valley Rd., Suite 1400, Wayne, PA 19087, 2009.
- Clinical and Laboratory Standards Institute (CLSI). Performance
Standards for Antimicrobial Disk Susceptibility Test; Approved Standard –
10th ed. CLSI Document M02-A10. CLSI, 940 West Valley Rd., Suite 1400,
Wayne, PA 19087, 2009.
- Swanson-Biearman B, Dean BS, Lopez G, Krenzelok EP. The effects of
penicillin and cephalosporin ingestions in children less than six years of
age. Vet Hum Toxicol 1988;30:66-67.
AUGMENTIN ES-600 is a registered trademark of GlaxoSmithKline and is licensed
to Dr. Reddy's Laboratories Inc.
CLINITEST is a registered trademark of Miles, Inc.
CLINISTIX is a registered trademark of Bayer Corporation.
AUGMENTIN XR is a registered trademark of GlaxoSmithKline and is licensed to
Dr. Reddy's Laboratories Inc.
FLAVORx is a trademark of FLAVORx. Inc.
Dist.by: Dr. Reddy's Laboratories Inc.,
Bridgewater, NJ 08807
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