Pharmacodynamic properties: Co-amoxiclav is an antibacterial combination consisting of the antibiotic
Amoxycillin and the Beta-lactamase inhibitor Clavulanic acid. Amoxycillin has a broad spectrum of
bactericidal activity against many gram-positive &
gram-negative microorganisms but it is susceptible to degradation by beta-lactamases and therefore the
spectrum of activity does not include microorganisms, which produce these enzymes. Clavulanic acid
possesses the ability to inactivate a wide range of beta-lactamase enzymes commonly found in
microorganisms resistant to penicillins and cephalosporins. Thus Clavulanic acid in Moxaclav ® protects
Amoxycillin from degradation by beta-lactamase enzymes and effectively extends the antibiotic spectrum to
embrace a wide range of microorganisms.
Moxaclav ® is bactericidal to a wide range of organisms including:
Aerobes: Enterococcus faecalis, Enterococcus faecium, Streptococcus pyogenes, Streptococcus viridans,
Staphylococcus aureus, Coagulase negative staphylococci (including Staphylococcus epidermidis),
Corynebacterium species, Bacillus anthracis, Listeria monocytogenes.
Anaerobes: Clostridium species, Peptococcus species, Peptostreptococcus.
Aerobes: Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, Proteus mirabilis, Proteus
vulgaris, Klebsiella species, Salmonella species, Shigella species, Bordetella pertussis, Brucella species,
Neisseria gonorrhoeae, Neisseria meningitidis, Vibrio cholerae, Pasteurella multocida.
Anaerobes: Bacteroides species including B fragilis.
Pharmacokinetic properties: The pharmacokinetics of the two components of Co-amoxiclav are closely
matched. Peak serum levels of both occur about one hour after oral administration. Absorption of Coamoxiclav
is optimised at the start of a meal. Both clavulanate and amoxycillin have low levels of serum
binding; about 70% remains free in the serum. Doubling the dosage of Co-amoxiclav approximately doubles
the serum levels achieved.
is indicated for short-term treatment of bacterial infections at the following sites:
1. Upper respiratory tract infections (including ENT) e.g. tonsillitis, sinusitis, otitis media.
2. Lower respiratory tract infections e.g. acute and chronic bronchitis, lobar and bronchopneumonia.
3. Genito-urinary tract infections e.g. cystitis, urethritis, pyelonephritis.
4. Skin and soft tissue infections.
5. Bone and joint infections e.g. osteomyelitis.
6. Other infections e.g. septic abortion, puerperal sepsis, intra-abdominal sepsis, etc.
DOSAGE & ADMINISTRATION:
Adults and children over 12 years:
The usual adult dose is one Moxaclav®
625mg tablet every 12 hours or one Moxaclav®
375 mg tablet
every 8 hours.
For more severe infections and infections of the respiratory tract, the dose should be one Moxaclav®
tablet every 12 hours
or one Moxaclav®
625mg tablet every 8 hours.
For Moxaclav suspension:
Children 6-12 years : 2 teaspoonful every 8 hours.
Children 1-6 years : 1 teaspoonful every 8 hours.
Children below 1 year : 25 mg/kg/day in divided doses every 8 hours, for example a 7.5 kg child would
require 2 ml Moxaclav ®
Treatment should not be extended beyond 14 days without review.
For Moxaclav ® Forte suspension:
The usual recommended daily dosage is: 25/3.6 mg/kg/day in mild to moderate infections (upper respiratory
tract infections e.g. recurrent tonsilitis, lower respiratory infections, and skin and soft tissue infections)
45/6.4 mg/kg/day for the treatment of more serious infections (upper respiratory tract infections, e.g. otitis
media and sinusitis, lower respiratory infections e.g. bronchopneumonia, and urinary tract infections)
The tables below give guidance for children.
Children of 2 to 12 years:
25/3.6 mg/kg/day 2-6 years (13-21 kg) 2.5 ml suspension b.i.d
7-12 years (22-40 kg) 5.0 ml suspension b.i.d
45/6.4 mg/kg/day 2-6 years (13-21 kg) 5.0 ml suspension b.i.d
7-12 years (22-40 kg) 10.0 ml suspension b.i.d
Dosage in renal impairment:
The dose should be adjusted in case of patients with renal impairment.
Mild impairment (Creatinine clearance > 30 ml/min): No change in dose.
Moderate impairment (Creatinine clearance 10- 30 ml/min): One Moxaclav ® tablet or one Moxaclav ®
mg tablet 12 hourly.
Severe impairment (Creatinine clearance < 10 ml/min): Not more than one Moxaclav ® tablet 12 hourly;
625 tablet is not recommended.
Similar reductions in dose should be made for children.
Dosage in hepatic impairment:
Dose with caution; monitor hepatic function at regular intervals.
may be taken without regard to meals; however, absorption of Clavulanate potassium is
enhanced when Amoxicillin/Clavulanic acid is administered at the start of a meal. To minimize the potential
for gastrointestinal intolerance, Amoxicillin/Clavulanic acid should be taken at the start of the meal.
PRECAUTION & WARNING:
Co-amoxiclav should be used with care in patients on anti-coagulation therapy or with severe hepatic
dysfunction. In patients with moderate or severe renal impairment, dosage should be adjusted. During the
administration of high dose of Moxaclav ®
adequate fluid intake and urinary output should be maintained to
minimize the possibility of crystalluria.
Penicillin hypersensitivity. Attention should be paid to possible cross sensitivity with other beta-lactam
antibiotics e.g. cephalosporins.
A previous history of Co-amoxiclav or penicillin associated cholestatic jaundice.
Side effects, as with Amoxycillin, are uncommon and mainly of a mild and transitory nature. Diarrhoea,
pseudomembranous colitis, indigestion, nausea, vomiting and candidiasis have been reported. If
gastrointestinal side effects occur with oral therapy, that may be reduced by taking Co-amoxiclav at the start
of meals. Hepatitis and cholestatic jaundice have been reported rarely but are usually reversible. Urticarial
and erythematous rashes sometimes occur. Rarely erythema multiforme, Stevens-Johnson
Syndrome and exfoliative dermatitis have been reported. In common with other beta-lactam antibiotics
angioedema and anaphylaxis have been reported.
Prolongation of bleeding time and prothrombin time have been reported in some patients receiving Coamoxiclav.
In common with other broad-spectrum antibiotics, Co-amoxiclav may reduce the efficacy of oral
contraceptives and patient should be warned accordingly.
Concomitant use of allopurinol during treatment with amoxycillin can increase the likelihood of allergic skin
reactions. There are no data on the concomitant use of Co-amoxiclav and allopurinol.
USE IN PREGNANCY & LACTATION:
Animal studies with orally and parenterally administered Co-amoxiclav have shown no teratogenic effect.
The drug has been used orally in human pregnancy in a limited number of cases with no untoward effect;
however use of Co-amoxiclav in pregnancy is not recommended unless considered essential by the
physician. During lactation, trace quantities of amoxycillin can be detected in breast milk.
Problems of overdose with Co-amoxiclav are unlikely to occur, if encountered gastrointestinal symptoms
and disturbance of the fluid and electrolyte balances may be evident. Co-amoxiclav may be removed from
the circulation by haemodialysis.