Amoxicillin with clavulanic acid – therapeutic signposts Review article

Abstract

Amoxicillin with clavulanic acid is a frequently used antibiotic for the treatment of respiratory tract infections in children, especially when amoxicillin alone is insufficient. In the treatment of acute otitis media, the introduction of pneumococcal vaccines has changed the epidemiology, increasing the involvement of β-lactamase-producing bacteria, such as Haemophilus influenzae and Moraxella catarrhalis. Although amoxicillin remains the first-line treatment, amoxicillin with clavulanic acid is recommended for acute otitis media in children aged 6 months to 12 years, particularly when β-lactamase-producing bacteria are suspected, amoxicillin treatment has failed, recurrent infections occur, or in patients at risk. In daily practice, the combination of amoxicillin with clavulanic acid at a concentration of 90 mg/6.4 mg/kg/24 h is very helpful in severe infections. Strengthening the profile by increasing the amoxicillin dose expands the spectrum of amoxicillin’s antibacterial activity to most penicillin-resistant strains, including strains with elevated amoxicillin minimum inhibitory concentrations. In the case of community-acquired pneumonia, amoxicillin with clavulanic acid is crucial in situations where narrow-spectrum antibiotics are insufficient. It is considered when β-lactamase-positive bacteria are suspected, amoxicillin treatment has failed, or in hospitalized children with moderate to severe community-acquired pneumonia of unknown etiology. The duration of community-acquired pneumonia therapy is typically 5–10 days. Rational use of this antibiotic, according to guidelines, is crucial to minimize the development of antibiotic resistance.