Buy Augmentin Online

Description of the dosage form

Powder: white or almost white, with a characteristic odor. Once diluted, a suspension of white or almost white forms. When standing, a white or almost white precipitate slowly forms.

Pharmacological action

Pharmacological action - bactericide, broad antibacterial spectrum.

Pharmacodynamics

Amoxicillin is a broad spectrum semi-synthetic antibiotic with activity against many Gram positive and Gram negative microorganisms. At the same time, amoxicillin is susceptible to destruction by beta-lactamases, and therefore the spectrum of activity of amoxicillin does not extend to the microorganisms that produce this enzyme.

Clavulanic acid, a beta-lactamase inhibitor structurally linked to penicillins, has the ability to inactivate a wide range of beta-lactamases found in microorganisms resistant to penicillins and cephalosporins.

Clavulanic acid has sufficient efficacy against plasmid beta-lactamases, which most often determine the resistance of bacteria, and less effective against chromosomal beta-lactamases of the 1st type, which are not inhibited by clavulanic acid.

The presence of clavulanic acid in the preparation of Augmentin protects amoxicillin from destruction by enzymes - beta-lactamases, which broadens the antibacterial spectrum of amoxicillin.

Pharmacokinetics

Aspiration

The two active ingredients in the Augmentin preparation - amoxicillin and clavulanic acid - are rapidly and completely absorbed from the gastrointestinal tract after oral administration. The absorption of the active ingredients in the drug Augmentin is optimal if the medication is taken at the start of a meal.

The pharmacokinetic parameters of amoxicillin and clavulanic acid obtained in different studies are presented below, when healthy volunteers aged 2 to 12 years on an empty stomach took 40 mg + 10 mg / kg / day of the drug Augmentin in three doses, powder for oral suspension, 125 mg + 31.25 mg in 5 ml (156.25 mg).

As with the iv introduction of a combination of amoxicillin with clavulanic acid, therapeutic concentrations of amoxicillin and clavulanic acid are found in various tissues and interstitial fluids (gallbladder, abdominal tissue, skin, adipose tissue and muscle, synovial and peritoneal fluids, bile, purulent discharge)).

Amoxicillin and clavulanic acid have a low degree of binding to plasma proteins. Studies have shown that around 25% of the total amount of clavulanic acid and 18% of amoxicillin in the blood plasma bind to plasma proteins.

In animal studies, no combination of the components of the preparation Augmentin in any organ was found.

Amoxicillin, like most penicillins, passes into breast milk. Traces of clavulanic acid can also be found in breast milk. With the exception of the possibility of developing diarrhea and candidiasis of the mucous membranes of the oral cavity, no other negative effect of amoxicillin and clavulanic acid on the health of breastfed infants is unknown.

Animal reproduction studies have shown that amoxicillin and clavulanic acid cross the placenta. However, no adverse effects on the fetus were detected.

Indications of the drug Augmentin

The combination of amoxicillin with clavulanic acid is indicated for the treatment of bacterial infections of the following locations caused by microorganisms susceptible to the combination of amoxicillin with clavulanic acid:

• upper respiratory tract infections (including ENT infections), for example, recurrent tonsillitis, sinusitis, otitis media, commonly caused by Streptococcus pneumoniae, Haemophilus influenzae1, Moraxella catarrhalis1 and Streptococcus pyogenes; (except for Augmentin 250 mg / 125 mg tablets); lower respiratory tract infections, such as exacerbations of chronic bronchitis, lobar pneumonia and bronchopneumonia, usually caused by Streptococcus pneumoniae, Haemophilus influenzae1 and Moraxella catarrhalis1;
• urinary tract infections, such as cystitis, urethritis, pyelonephritis, female genital infections, usually caused by species of the family Enterobacteriaceae1 (mainly Escherichia coli1), Staphylococcus saprophyticus and Enterococcus, as well as gonorrhea caused by Neisseria gonorrhoeae1; skin and soft tissue infections, usually caused by Staphylococcus aureus1, Streptococcus pyogenes and species of the genus Bacteroides1;
• infections of the bones and joints, for example osteomyelitis, usually caused by Staphylococcus aureus1, if necessary, prolonged treatment is possible.
• odontogenic infections, for example periodontitis, odontogenic maxillary sinusitis, severe dental abscesses with spread of cellulite (only for Augmentin tablets, dosages 500 mg / 125 mg, 875 mg / 125 mg);
• other mixed infections (e.g. septic abortion, postpartum septicemia, intra-abdominal septicemia) as part of phased therapy (only for the dosage forms Augmentin of 250 mg / 125 mg, 500 mg / 125 tablets mg, 875 mg / 125 mg);
• 1 Individual representatives of the specified type of microorganism produce beta-lactamase, which makes them insensitive to amoxicillin (see "Pharmacodynamics").
• Infections caused by microorganisms sensitive to amoxicillin can be treated with Augmentin, because amoxicillin is one of its active ingredients.
• Augmentin is also indicated for the treatment of mixed infections caused by microorganisms sensitive to amoxicillin, as well as micro-organisms producing beta-lactamase, sensitive to the combination of amoxicillin with clavulanic acid.

The sensitivity of bacteria to the combination of amoxicillin and clavulanic acid varies by region and over time. Where possible, local sensitivity data should be taken into account. If necessary, microbiological samples should be taken and analyzed for bacteriological sensitivity.

Cons-indications

• hypersensitivity to amoxicillin, clavulanic acid, other components of the drug, beta-lactams (e.g. penicillins, cephalosporins) in history;
• history of jaundice or liver failure when using a combination of amoxicillin with clavulanic acid in history.
• In addition, for the powder for oral suspension, 125 mg + 31.25 mg
• phenylketonuria.
• In addition, for the powder for oral suspension, 200 mg + 28.5 mg, 400 mg + 57 mg
• phenylketonuria;
• impaired renal function (Cl creatinine less than 30 ml / min);
• age of children up to 3 months.
• Additionally for film-coated tablets, 250 mg + 125 mg, 500 mg + 125 mg
• children under 12 or body weight less than 40 kg.
• In addition, for film-coated tablets, 875 mg + 125 mg
• impaired renal function (Cl creatinine less than 30 ml / min);
• children under 12 or body weight less than 40 kg.
• Precautions: impaired liver function.

Pregnancy and breast feeding

In studies of reproductive functions in animals, oral and parenteral administration of Augmentin did not cause teratogenic effects.

In a single study in women with premature rupture of the membranes, it was found that preventive treatment with Augmentin could be associated with an increased risk of necrotizing enterocolitis in newborns. Like all medicines, Augmentin is not recommended for use during pregnancy, unless the expected benefit to the mother outweighs the potential risk to the fetus.

The drug Augmentin can be used during breast-feeding. With the exception of the possibility of developing diarrhea or candidiasis of the mucous membranes of the oral cavity associated with the penetration into breast milk of traces of active substances of this drug, no other undesirable effects have been observed in breast-fed infants . In the event of adverse effects in breastfed infants, breastfeeding should be discontinued.

Side effects

The adverse events presented below are listed according to the damage to organs and organ systems and the frequency of their occurrence. The frequency of occurrence is determined as follows: very often - ≥1 / 10; often - ≥1 / 100 and <1/10; rarely - ≥1 / 1000 and <1/100; rarely - ≥1 / 10,000 and <1/1000; very rarely - <1/10000, including isolated cases. Frequency categories were formed based on clinical studies of the drug and post-registration observation.

Infectious and parasitic diseases: often - candidiasis of the skin and mucous membranes.

From the blood and lymphatic system: rarely - reversible leukopenia (including neutropenia), reversible thrombocytopenia; very rarely - reversible agranulocytosis and reversible hemolytic anemia, prolonged bleeding and PV, anemia, eosinophilia, thrombocytosis. On the part of the immune system: very rarely - angioedema, anaphylactic reactions, syndrome similar to serum sickness, allergic vasculitis.

From the nervous system: seldom - dizziness, headache; very rarely - reversible hyperactivity, seizures (seizures can occur in patients with kidney failure, as well as in those receiving high doses of medication), insomnia, restlessness, anxiety, and behavior change.

From the gastrointestinal tract:

• adults: very often - diarrhea; often - nausea, vomiting;
• children: often - diarrhea, nausea, vomiting;
• entire population: nausea was most often associated with the use of high doses of the drug. If after the start of taking the drug, there are undesirable reactions from the gastrointestinal tract, they can be eliminated if Augmentin is taken at the start of the meal; rarely - digestion; very rarely - colitis associated with antibiotics (including pseudomembranous colitis and hemorrhagic colitis), black "hairy" tongue, gastritis, stomatitis; discoloration of the surface layer of dental enamel in children. Oral care helps prevent discoloration of your teeth because you only need to brush your teeth.
• From the liver and bile ducts: rarely - a moderate increase in the activity of AST and / or ALT. This phenomenon is observed in patients receiving beta-lactam antibiotic therapy, but its clinical significance is unknown. Very rarely - hepatitis and cholestatic jaundice. These phenomena are observed in patients treated with penicillin antibiotics and cephalosporins. Increased concentrations of bilirubin and alkaline phosphatase.

Adverse liver effects are seen mainly in men and elderly patients and may be associated with long-term treatment. These adverse events are very rarely observed in children.

The signs and symptoms listed usually occur during or immediately after treatment, but in some cases they may not appear for several weeks after treatment has ended. Adverse events are generally reversible. Hepatic adverse events can be serious, in extremely rare cases, fatal effects have been reported. In almost all cases, these were patients with serious concomitant pathology or patients receiving potentially hepatotoxic drugs.

From the skin and subcutaneous tissue: rarely - rash, itching, hives; rarely polymorphic erythema; very rarely - Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative bullous dermatitis, generalized acute exanthematic pustulosis.

In case of allergic skin reactions, treatment with Augmentin should be stopped.

From the kidneys and urinary tract: very rarely - interstitial nephritis, crystalluria (see "Overdose"), hematuria.

The interaction

The simultaneous use of the drug Augmentin and probenecid is not recommended. Probenecid reduces the tubular secretion of amoxicillin and, therefore, the simultaneous use of the drug Augmentin and probenecid may lead to an increase and persistence in the blood level of amoxicillin, but not of clavulanic acid.

The simultaneous use of allopurinol and amoxicillin may increase the risk of allergic skin reactions. Currently, there are no data in the literature on the simultaneous use of a combination of amoxicillin with clavulanic acid and allopurinol.

Penicillins can slow the elimination of methotrexate from the body by inhibiting its tubular secretion, so the simultaneous use of the drug Augmentin and methotrexate can increase the toxicity of methotrexate.

Like other antibacterial drugs, Augmentin can affect the intestinal microflora, resulting in decreased absorption of estrogen from the gastrointestinal tract and reduced effectiveness of combined oral contraceptives.

The literature describes rare cases of increased MHO in patients with the combined use of acenocoumarol or warfarin and amoxicillin. If necessary, the simultaneous administration of the Augmentin preparation with PV or MHO anticoagulants must be carefully monitored when prescribing or stopping the Augmentin preparation; a dose adjustment of anticoagulants for oral administration may be necessary.

Dosage and administration

Inside:

The dosing schedule is defined individually, depending on the patient's age, body weight, kidney function, and the severity of the infection. To reduce possible gastrointestinal disturbances and optimize absorption, the drug should be taken at the start of a meal. The minimum duration of antibiotic therapy is 5 days.

Treatment should not continue for more than 14 days without examining the clinical situation.

If necessary, it is possible to carry out a therapy in stages (first parenteral administration of the drug with subsequent transition to oral administration).

It should be remembered that 2 tab. Augmentin, 250 mg + 125 mg is not equivalent to 1 tablet. Augmentin, 500 mg + 125 mg. Adults and children 12 years and older or weighing 40 kg or more. It is recommended to use 11 ml of a suspension at a dose of 400 mg + 57 mg in 5 ml, which is equivalent to 1 table. Augmentin, 875 mg + 125 mg.

1 tab. 250 mg + 125 mg 3 times a day for infections of mild to moderate severity. In severe infections (including chronic and recurrent urinary tract infections, chronic and recurrent lower respiratory tract infections), other dosages of Augmentin are recommended.

1 tab. 500 mg + 125 mg 3 times a day.

1 tab. 875 mg + 125 mg 2 times a day.

Children aged 3 months to 12 years with a body weight less than 40 kg. The dose is calculated based on age and body weight, indicated in mg / kg / day or in ml of suspension. The daily dose is divided into 3 doses every 8 hours (125 mg + 31.25 mg) or 2 doses every 12 hours (200 mg + 28.5 mg, 400 mg + 57 mg). The recommended dosing schedule and frequency of administration are presented in the table below.

Low doses of Augmentin are recommended for the treatment of skin and soft tissue infections, as well as recurrent tonsillitis.

High doses of Augmentin are recommended for the treatment of diseases such as otitis media, sinusitis, lower respiratory and urinary tract infections, bone and joint infections.

There are insufficient clinical data to recommend the use of the drug Augmentin at a dose greater than 40 mg + 10 mg / kg in 3 divided doses (4: 1 suspension) in children under 2 years of age.

Children from birth to 3 months. Due to the immaturity of the excretory function of the kidneys, the recommended dose of Augmentin (calculation for amoxicillin) is 30 mg / kg / day in 2 doses divided into 4: 1 suspension. Babies born prematurely. There are no recommendations regarding the dosing regimen.

Special patient groups

Elderly patients. Correction of the dosing schedule is not required; the same dosing regimen is applied as in younger patients. In elderly patients with renal impairment, appropriate doses are prescribed for adult patients with renal impairment.

Patients with hepatic impairment. Treatment is carried out with caution; regularly monitor liver function. There is not enough data to change the dosage recommendations for these patients.

Patients with renal insufficiency. Correction of the dosing schedule is based on the maximum recommended dose of amoxicillin and the creatinine clearance value.

In most cases, if possible, parenteral therapy should be preferred. Hemodialysis patients. Powder for solution for oral administration: 15 mg + 3.75 mg / kg / day.

Before the hemodialysis session, an additional dose of 15 mg + 3.75 mg / kg should be administered. To restore the concentration of the active components of the drug Augmentin in the blood, a second additional dose of 15 mg + 3.75 mg / kg should be introduced after a hemodialysis session.

Film-coated tablets, 250 mg + 125 mg: dose adjustment according to the maximum recommended dose of amoxicillin.

2 tab. 250 mg + 125 mg in 1 dose every 24 hours.

During the dialysis session, 1 additional dose (1 tablet) and 1 other tablet. at the end of the dialysis session (to compensate for the decrease in serum concentrations of amoxicillin and clavulanic acid). Film-coated tablets, 500 mg + 125 mg: dose adjustment according to the maximum recommended dose of amoxicillin.

1 tab. 500 mg + 125 mg in 1 dose every 24 hours.

During the dialysis session, 1 additional dose (1 tablet) and 1 other tablet. at the end of the dialysis session (to compensate for the decrease in serum concentrations of amoxicillin and clavulanic acid).

The method of preparing the suspension

The suspension is prepared immediately before the first use. About 60 ml of boiled water cooled to room temperature should be added to the powder vial, then close the vial with a lid and shake until the powder is completely diluted, let the vial stand for 5 minutes to ensure dilution complete. Then add water to the mark on the bottle and shake the bottle again. In general, approximately 92 ml of water is necessary to prepare a suspension for a dosage of 125 mg + 31.25 mg and 64 ml of water for a dosage of 200 mg + 28.5 mg and 400 mg + 57 mg.

The bottle should be shaken well before each use. For a precise dosage of the drug, use a measuring cap which must be washed well with water after each use. After dilution, the suspension should not be stored for more than 7 days in the refrigerator, but not frozen.

For children under 2 years of age, a single measured dose of a suspension of Augmentin can be diluted with water in a ratio of 1: 1.

Overdose

Symptoms: can be observed from the gastrointestinal tract and disturbances of the water-electrolyte balance.

Amoxicillin crystalluria is described, which in some cases leads to the development of renal failure (see "Special instructions").

Convulsions in patients with kidney failure, as well as in those receiving high doses of the drug.

Treatment: gastrointestinal symptoms - symptomatic therapy, paying particular attention to the normalization of the water-electrolyte balance. Amoxicillin and clavulanic acid can be removed from the bloodstream by hemodialysis.

The results of a prospective study, carried out with the participation of 51 children in a poison control center, showed that the administration of amoxicillin at a dose lower than 250 mg / kg did not cause significant clinical symptoms and did not require gastric lavage.

Special instructions

Before starting treatment with Augmentin, it is necessary to collect a detailed medical history concerning previous hypersensitivity reactions to penicillins, cephalosporins or other substances which cause an allergic reaction in the patient.

Severe and sometimes fatal hypersensitivity reactions (anaphylactic reactions) to penicillins are described. The risk of such reactions is higher in patients with a history of hypersensitivity reactions to penicillins. In the event of an allergic reaction, it is necessary to stop treatment with Augmentin and to start an appropriate alternative treatment. In case of severe anaphylactic reactions, epinephrine should be administered to the patient immediately. It may also require oxygen therapy, iv administration of corticosteroids, and management of the airways, including intubation.

When suspected of infectious mononucleosis, Augmentin should not be used, because in patients with this disease, amoxicillin can cause a rash similar to measles, which complicates the diagnosis of the disease. Long-term treatment with Augmentin may cause excessive reproduction of insensitive microorganisms.

In general, Augmentin is well tolerated and has a low toxicity characteristic of all penicillins. During prolonged treatment with Augmentin, it is recommended to periodically assess the function of the kidneys, liver and hematopoiesis.

To reduce the risk of side effects from the gastrointestinal tract, the drug should be taken at the start of a meal.

In patients receiving a combination of amoxicillin with clavulanic acid with indirect (oral) anticoagulants, in rare cases, an increase in PV (increase in MHO) has been reported. With the joint appointment of indirect (oral) anticoagulants with a combination of amoxicillin and clavulanic acid, monitoring of the relevant indicators is necessary. To maintain the desired effect of oral anticoagulants, dose adjustment may be necessary.

In patients with renal impairment, the dose of Augmentin should be prescribed depending on the degree of impairment (see "Dosage and Administration", Patients with renal impairment).

In patients with reduced diuresis, crystalluria occurs very rarely, mainly with parenteral therapy. When administering large doses of amoxicillin, it is recommended that you take sufficient fluid and maintain adequate diuresis to reduce the likelihood of amoxicillin crystal formation (see "Overdose").

Taking the drug Augmentin indoors leads to a high content of amoxicillin in the urine, which can lead to false positive results in the determination of glucose in the urine (for example, the Benedict test, the Feling test ). In this case, it is recommended to use the glucose oxidation method to determine the concentration of glucose in the urine.

Oral care helps prevent discoloration of the teeth associated with taking the medication, as it is enough to brush your teeth (for suspensions).

It is necessary to use the drug Augmentin within 30 days from the opening of the packaging of the laminated aluminum foil (for tablets) Abuse and addiction. No drug dependence, dependence and euphoria reactions associated with the use of the drug Augmentin have been observed.

Influence on the ability to drive and work with mechanisms. Since the drug can cause dizziness, it is necessary to warn patients about the precautions to take when driving a vehicle or working with moving machinery.

Release form

Powder for oral suspension, 125 mg + 31.25 mg in 5 ml. In a transparent glass bottle, closed by an aluminum screw cap with control of the first opening, 11.5 g. 1 fl. with a measuring cap in a cardboard package.

Powder for oral suspension, 200 mg + 28.5 mg in 5 ml, 400 mg + 57 mg in 5 ml. In a transparent glass bottle closed by an aluminum screw cap with a first opening control, 7.7 g (for a dosage of 200 mg + 28.5 mg in 5 ml) or 12.6 g (for a dosage 400 mg + 57 mg in 5 ml) 1 fl. with a dosing cap or a dosing syringe in a cardboard package.

Film-coated tablets, 250 mg + 125 mg. In aluminum / PVC blister 10 pcs. 1 blister with a bag of silica gel in a laminated aluminum foil package. 2 packs of aluminum foil in a cardboard box.

Film-coated tablets, 500 mg + 125 mg. In aluminum / PVC / PVDC blister 7 or 10 pcs. 1 blister with a bag of silica gel in a laminated aluminum foil package. 2 packs of laminated aluminum foil in a cardboard box.

Film-coated tablets, 850 mg + 125 mg. In aluminum / PVC blister 7 pcs. 1 blister with a bag of silica gel in a laminated aluminum foil package. 2 packs of aluminum foil in a cardboard box.

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