What is the appropriate dosing of Amoxicillin-Clavulanate (Amoxaclav) for a patient with Impaired renal function undergoing hemodialysis and diagnosed with acute otitis media?

From the Guidelines

For a hemodialysis patient with acute otitis media, Amoxaclav should be dosed at 500/125 mg every 24 hours, with an additional dose after each hemodialysis session, as the standard dosing may lead to drug accumulation and potential toxicity due to significant renal elimination of both amoxicillin and clavulanic acid 1. When treating acute otitis media, the choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present.

• Amoxicillin is recommended as first-line therapy for AOM because it is generally effective when used in sufficient doses against susceptible and intermediate resistant pneumococci, as well as being safe, inexpensive, and having an acceptable taste and narrow microbiologic spectrum 1.
• The dosage of amoxicillin should be 80 to 90 mg per kg per day, but for hemodialysis patients, this needs to be adjusted due to renal elimination.
• For severe infections, consider 875/125 mg every 24 hours, but always consider the patient's renal function and adjust the dose accordingly.
• A typical treatment duration for acute otitis media is 5-7 days, but this may vary depending on the patient's response to treatment.
• Monitor for signs of efficacy and adverse effects such as diarrhea, nausea, or skin rash, and adjust the treatment plan as needed.
• If the patient has a penicillin allergy, alternative options include trimethoprim-sulfamethoxazole or a fluoroquinolone with appropriate renal dose adjustments, ensuring the first dose is administered immediately after diagnosis to quickly achieve therapeutic levels.

From the FDA Drug Label

Table 2 Dosing in Patients with Severe Renal Impairment Patients with Renal Impairment Dosage Regimen GFR 10 to 30 mL/min 500 mg or 250 mg every 12 hours, depending on the severity of the infection GFR less than 10 mL/min 500 mg or 250 mg every 24 hours, depending on severity of the infection Hemodialysis 500 mg or 250 mg every 24 hours, depending on severity of the infection Administer an additional dose both during and at the end of dialysis

For a hemodialysis patient with acute otitis media, the recommended dosage of amoxicillin is 500 mg or 250 mg every 24 hours, depending on the severity of the infection. An additional dose should be administered both during and at the end of dialysis 2.

From the Research

Amoxaclav Dosing for Hemodialysis Patients with Acute Otitis Media

• The ideal dosing strategy for amoxicillin/clavulanic acid (amoxaclav) in hemodialysis patients with acute otitis media is not directly addressed in the provided studies 3, 4, 5, 6, 7.
• However, study 4 discusses the importance of optimizing antimicrobial dosing strategies for patients receiving chronic intermittent hemodialysis, including thrice-weekly postdialytic administration of select antimicrobial agents.
• Studies 5, 6, and 7 provide information on the effectiveness and dosing of amoxaclav in treating acute otitis media in pediatric patients, but do not specifically address hemodialysis patients.
• It is essential to consider the patient's renal function and the dialysis schedule when determining the optimal dosing regimen for amoxaclav in hemodialysis patients with acute otitis media 4.
• The dosing frequency and duration of amoxaclav treatment may need to be adjusted based on the patient's individual needs and the severity of the infection.
• Further research is needed to provide specific guidance on amoxaclav dosing for hemodialysis patients with acute otitis media.

Key Considerations

• Hemodialysis patients may require adjusted dosing regimens due to their impaired renal function 4.
• The choice of antibiotic and dosing regimen should be based on the severity of the infection, the patient's renal function, and the dialysis schedule.
• Studies 5, 6, and 7 suggest that amoxaclav can be an effective treatment for acute otitis media, but the optimal dosing regimen for hemodialysis patients is not well established.
• The use of thrice-weekly postdialytic administration of antimicrobial agents, as discussed in study 4, may be a consideration for hemodialysis patients with acute otitis media.