They are based on the antibacterial activity and pharmacokinetic characteristics of this drug. They take account both of the clinical studies to which it gave rise and of its place in the range of antibacterial products currently available.
They are limited to infections caused by organisms known to be sensitive, in particular to certain situations where the bacterial species responsible for infection can be multiple and / or resistant to the antibiotics currently available.
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On this basis, this medicinal product is of particular interest in the following indications:
· Acute otitis media of the adult
· Acute maxillary sinusitis and other forms of sinusitis
· Superinfections of acute bronchitis of the patient at risk, in particular chronic ethyl alcohol, tobacco, elderly, over 65 years, in case of evolutive risk or in second;
· Exacerbations of chronic bronchopneumonia
Acute pneumonia of the at-risk patient, in particular chronic ethyl alcohol, tobacco, over 65 years of age or with swallowing disorders
Acute recurrent cystitis, uncomplicated cystitis of the woman and pyelonephritis, uncomplicated acute from germs, sensitive
· High gynecological infections, in combination with another active antibiotic on Chlamydiae (see section 4.4).
· Severe stomatal infections: abscess, phlegmons, cellulitis
· Relay treatment of the injectable route.
Official recommendations concerning the appropriate use of antibacterials should be taken into account.
Posology expressed in amoxicillin
ADULTS (weight ≥ 40 kg)
In patients with renal function, normal
· 2 g / day in 2 taken in the following indications
O, acute maxillary sinusitis
Acute bronchitis of the patient at risk, especially chronic ethyl alcohol, tobacco, over 65 years of age, in case of risk, evolutive or second intention
O Exacerbations of chronic bronchopneumonia
O, periodontitis.
· 3 g / day in 3 taken in the following indications
O other forms of sinusitis
O, otitis media acute
Acute recurrent cystitis, uncomplicated cystitis of the woman and pyelonephritis, uncomplicated acute germs, sensitive
O upper gynecological infections, in combination with another active antibiotic on Chlamydiae (see Warnings and Precautions for Use)
O: severe stomatal infections: abscess, phlegmons, cellulitis
Acute pneumonitis of the at-risk patient, especially chronic ethyl, tobacco, elderly, over 65 years or with swallowing disorders
16; mg / l
MIC, pneumococcus: S £ 0.5, mg / l and R> 2 mg / l
The prevalence of acquired resistance may vary according to geography and time for some species. It is therefore useful to have information on the prevalence of local resistance, especially for the treatment of severe infections. These data can only provide guidance on the probabilities of the susceptibility of a bacterial strain to this antibiotic.
When the variability of the resistance prevalence in France is known for a bacterial species, it is indicated in the table below
Categories
Frequency of resistance, acquired in France (> 10%) (extreme values)
SENSITIVE SPECIES
Gram-positive aerobes
Corynebacterium diphtheriae
Enterococcus faecalis
Erysipelothrix rhusiopathiae
Listeria monocytogenes
Nocardia asteroids
Staphylococcus méti-S
Streptococcus
Streptococcus bovis
Streptococcus pneumoniae
15 - 35%
Gram-negative Aerobes
Actinobacillus actinomycetemcomitans
Bordetella pertussis
Branhamella catarrhalis
Burkholderia pseudo-mallei
Campylobacter
Capnocytophaga
Citrobacter koseri
Eikenella
Escherichia coli
10 - 30%
Haemophilus influenzae
Haemophilus para-influenzae
Klebsiella
0 - 20%
Neisseria gonorrhoeae
Neisseria meningitidis
Pasteurella multocida
Proteus, mirabilis
10 - 20%
Proteus, vulgaris
Salmonella
0 - 40%
Shigella
0 - 30%
Vibrio cholerae
Categories
Frequency of resistance, acquired in France (> 10%) (extreme values)
Anaerobes
Actinomyces
Bacteroides
Clostridium
Eubacterium
Fusobacterium
Peptostreptococcus
Porphyromonas
Prevotella
Propionibacterium acnes
Veillonella
Other
Bartonella
Borrelia
Leptospira
Treponema
MODERATELY SENSITIVE SPECIES
(In vitro sensitivity, intermediate)
Gram-positive aerobes
Enterococcus faecium
40 - 80%
RESISTANT SPECIES
Gram-positive aerobes
Staphylococcus meti-R; *
Gram-negative Aerobes
Acinetobacter
Citrobacter freundii
Enterobacter
Legionella
Morganella morganii
Proteus; rettgeri
Providencia
Pseudomonas
Serratia
Yersinia; enterocolitica
Categories
Other
Chlamydia
Coxiella
Mycobacterium
Mycoplasma
Rickettsia
* The frequency of resistance to methicillin is approximately 30 to 50% of all staphylococci and is found mainly in hospital.
Not applicable.
This medicinal product should NEVER be used in cases of
· Allergy to antibiotics of the beta-lactam family (penicillins, cephalosporins): take into account the risk of cross-allergicity with the antibiotics in the group, cephalosporins
· Allergy to any component of the drug
· A history of hepatic involvement related to the association of amoxicillin / clavulanic acid
This medication is GENERALLY NOT RECOMMENDED for use in combination with methotrexate (see section Interactions with other medicinal products and other forms of interaction). Code>
Special warnings
The occurrence of any manifestation, allergic necessitates the cessation of treatment and the setting up of a suitable treatment.
Immuno-allergic reactions, of which severe and sometimes fatal hypersensitivity reactions (anaphylaxis) have been observed exceptionally in patients treated with beta-lactam antibiotics. Code>
Their administration therefore requires an examination for discovery.
In the face of a history of a typical allergy to these products, the contraindication is formal.
Allergy to penicillins is crossed with cephalosporin allergy in 5 to 10% of cases. This leads to the proscription of penicillins when the subject is a known allergic to cephalosporins.
Precautions for use
As with all beta-lactams, regularly check the blood formula when administering high doses of amoxicillin
The administration of high doses of beta-lactams in patients with renal insufficiency or in patients with predisposing factors such as a history of seizures, epilepsy, treatment or meningeal involvement may exceptionally lead to convulsions
For renal insufficiency, for creatinine clearances less than or equal to 30 ml / min, adjust dosage (see Dosage and Mode of Administration). >
The risk of occurrence of a hepatic adverse effect (cholestasis) is increased, with treatment greater than 10 days and all, especially after 15 days.
In case of prolonged treatment, it is recommended to monitor the liver and kidney functions.
The combination of amoxicillin / clavulanic acid should be used with caution, in case of hepatic impairment
This medicinal product contains 12.27 mg (0.31 mmol) potassium per tablet (24.54 mg per dose): take this into account in people on a diet, hypokalaemic.
Paraclinical examinations
Impact on biological parameters
A positivity of the direct Coombs test was obtained during treatment with beta-lactams. This may also occur in subjects treated with amoxicillin / clavulanic acid. False positivations of this test linked to the presence of clavulanic acid have also been observed.
A very high concentrations, amoxicillin tends to
· Decrease the results of blood glucose measurements
· Interferes in the determinations of the total serum protein by color reaction
· Give a false positive color reaction in the glycosuria assays by the colorimetric semi-quantitative method
Associations, deprecated
+ Methotrexate
Increased hematological effects and toxicity of methotrexate by inhibition of renal tubular secretion by penicillins
Associations to be taken into account
+ Allopurinol (and extrapolation, other inhibitors of uricosynthesis)
Increased risk of skin reactions
Special Problems of the INR imbalance
Many cases of increased oral anticoagulant activity have been reported in patients receiving antibiotics. The marked infectious or inflammatory context, age and general condition of the patient appear as risk factors. In these circumstances, it is difficult to distinguish between infectious pathology and its treatment in the onset of INR imbalance, although some classes of antibiotics are more involved: these include fluoroquinolones , Macrolides, cyclins, cotrimoxazole and certain cephalosporins.
Not applicable.
The manifestations of overdose may be neuropsychic, renal (crystalluria) and digestive. Treatment is symptomatic by monitoring, particularly balance, hydroelectrolyte. Amoxicillin and clavulanic acid can be eliminated by hemodialysis
Pregnancy
For amoxicillin there are no reliable data for teratogenesis in animals
In clinical studies, epidemiological studies have not revealed any malformative or fetotoxic effects related to the use of amoxicillin
For clavulanic acid, studies in animals have not demonstrated teratogenicity. In the absence of teratogenic effect in animals, a malformative effect in the human species is not expected. Indeed, to date, the substances responsible for malformations in the human species have been shown to be teratogenic in animals during studies, well conducted on two species
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Clinically, the use of clavulanic acid in a limited number of pregnancies has apparently shown no particular malformative or fetotoxic effects to date. However, further studies are needed to evaluate the consequences of exposure during pregnancy.
Accordingly, the combination of amoxicillin / clavulanic acid may be prescribed during pregnancy if necessary.
Breastfeeding
The passage of amoxicillin-clavulanic acid into breast milk is low and the amounts ingested are much lower than the therapeutic doses. Accordingly, breast-feeding is possible if this antibiotic is taken.
However, discontinue breast-feeding (or medication) in the event of diarrhea, candidiasis, or rash in the infant.
· Digestive symptoms: nausea, vomiting, possibility of digestive superinfections to Candida, diarrhea, loose stools, dyspepsia and abdominal pain Some cases of pseudomembranous colitis and colitis haemorrhagic have been reported. >
Allergic manifestations include urticaria, eosinophilia, angioedema, discomfort, respiratory disease, serum sickness, vasculitis, exceptionally anaphylactic shock.
Severe cases of Lyell's syndrome, Stevens-Johnson syndrome, erythema multiforme, and exfoliative dermatitis have been reported. May be more frequent and / or more intense in patients with infectious mononucleosis or developing lymphoid leukemia Very rare cases of acute exanthematous pustulosis (see Warnings and Precautions for Use).
· Other manifestations have been reported, more rarely
O cases of hepatitis, usually cholestatic, or mixed, have been occasionally reported.These cases appear to occur more readily in elderly and male patients and in treatment of more than 10 days and in particular For treatments, greater than 15 days. Symptoms, such as jaundice which appears to be constant, appear during or at the end of treatment, but may occur a few weeks after discontinuation. The histopathological examination of the liver usually reveals a centro-lobular cholestasis. The evolution is generally favorable but can be prolonged for a few weeks A few extremely rare cases of fatal evolution have been observed
O moderate and asymptomatic increases in ASAT, ALAT or alkaline phosphatase
O interstitial nephritis, acute
Leucopenia, neutropenia, agranulocytosis, hemolytic anemia, thrombocytopenia, reversible
Cases of convulsions have been reported exceptionally (see section 4.4).
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