PK/PD/PG: rapid absorption w or w/o food, excreted in urine 60% unchanged, time to peak 1 hr, 20% protein binding, time-dependent, posti-abx effect

H/MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Regimen: 50 mg/kg once daily (max = 1000 mg); alternate:
25 mg/kg (max = 500 mg) twice daily

D: f pt has already taken amoxicillin, hx of recurrent infection unresponsive to amoxicillin should recieve high- dose Augmentin

Warnings: Serious hypersensitivity reactions, such as anaphylaxis and Stevens-Johnson syndrome, to amoxicillin or other beta-lactam antibiotics (eg, penicillins, cephalosporins); avoid use in pts with mononucleosis; c.diff infections

Interactions: can be taken with or without food; concurrent use with oral contraceptives can reduce effectiveness; TCAs; live typhoid and cholera vaccines have decreased effectiveness

Special Pop: No adj for hepatic impariment; DNU CrCl <30; Geriatric: watch for renal fxn; pediatrics use specified dosing adjustments; Risk B in pregnancy

Education: Drug may decrease effectiveness of oral contraceptives with concurrent use. Recommend additional form of birth control. This drug may cause diarrhea, nausea, vomiting, or rash.

H: Clavulanate inhibits beta-lactamases that inactivate amoxicillin. Amoxicillin inhibits bacterial cell wall synthesis by binding to the penicillin-binding proteins which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis

R: 500 mg every 8 to 12 hours or 875 mg every 12 hours; Extended release: 2 g every 12 hours

M: Assess patient for infection; with prolonged therapy, monitor renal, hepatic, and hematologic function; if hepatic impairment present, monitor LFTs; monitor for s/s anaphylaxis during first dose

W: anaphylaxis, diarrhea (CDAD can occur >2 mo post-abx tx)

I: tetracyclines, aminoglycosides; BCG, cholera, typhoid vaccine

S: renal impairment:
-CrCl 10-29 mL/min = 8-20 mg amox/kg/dose q24h
-CrCl <10 = 8-20 mg amox/kg/dose q24h

E: Drug may decrease effectiveness of oral contraceptives with concurrent use. Recommend additional form of birth control.

H: MOA: inhibits bacterial cell wall synthesis by binding to one or more of the penicillin- binding proteins which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.

Adverse drug reactions: headache, diarrhea, nausea, vomiting

R: regimen: Dose: 80-90 mg/kg/day orally divided twice daily

M: infection resolution, s/sx improvement (assess at beginning of therapy and throughout), anaphylaxis at first dose

D : if pt has already taken amoxicillin, has ppurulent conjunctivitis or hx of recurrent infection unresponsibe to amoxicillin should recieve high- dose Augmentin

W: warnings and contraindications: serious hypersensitivity,
superinfection: prolonged use may result in fungal or bacterial superinfection

I: Interactions: IR: can be taken with/ w/o food ER: food decreases rate but not extent of absorption

S: renal adjustments are needed, no hepatic adjustments needed, special dosing for pediatrics.

Education: side effects includ upset stomach. diarrhea, headache. Can be taken w/ wo food. Stoop taking if you have s/sx of an allergic rxn, unexplained bruising or bleding, fevers or chills

Duration: traiditonal duration = 10 days most experts agree therapy may be optimal at 5-7 days

Follows a viral upper respiratory tract infection that impairs the mucociliary apparatus and causes Eustachian tube dysfunction in the middle ear-space becomes blocked with fluid and bacteria from nasopharynx are not cleared in this space

Peds group: middle ear effusion, moderate-to-severe bulging of the tympanic membrane or new onset otorrhea not due to acute otitis externa or (2) mild bulging of the tympanic membrane and onset of ear pain within the last 48 hours or intense erythema of the tympanic membrane

not well defined-may have an alteration in host immunity, bacteria of the oropharynx may migrate to cause an infection

Often preceded by a viral respiratory tract infection that causes mucosal inflammation which can lead to obstruction of the pathways that drain the sinuses. Mucosal secretions become trapped, local defenses are impaired, and bacteria from adjacent surfaces begin to proliferate.

Sx compatible with acute rhinosinusitis lasting for 10+ days w/o improvement, onset of severe sx of high fever and purulent nasal discharge or face pain lasting 3+ consecutive days at beginning of illness, or onset with worsening sx (fever, headache or inc in nasal discharge) following a typical viral URI that lasted 5-6 days and were initially improving

Amoxicillin: Protein binding: ~20%. Half-life elimination: Adults: Immediate release: 61.3 minutes; extended release: 90 minutes. Time to peak: Capsule, oral suspension: 1 to 2 hours; chewable tablet: 1 hour; extended release: 3.1 hours. Excretion: Urine (60% as unchanged drug) lower in neonates.

Clavulanate: Protein binding: ~25%, Half-life elimination: 1 hour, Time to peak: 1.5 hours, Excretion: Urine (25% to 40% as unchanged drug)

primarily through clinical presentation; no simple/non-invasive diagnostic procedures exist