What is the dose of amoxicillin (Amoxicillin) clavulanate (Clavulanic acid) in a 59-year-old male patient with a body mass index (BMI) of 27 who has not responded to amoxicillin (Amoxicillin) therapy?

From the Guidelines

For a 59-year-old male with a BMI of 27 who didn't respond to amoxicillin, the recommended dose of amoxicillin-clavulanate is 4 g/250 mg per day, as this higher dose may be advantageous in areas with a high prevalence of penicillin-resistant S pneumoniae or for patients with risk factors for infection with a resistant pathogen 1.

Key Considerations

• The patient's lack of response to amoxicillin suggests potential resistance, making the higher dose of amoxicillin-clavulanate a more suitable option.
• The total daily dose of amoxicillin and the amoxicillin component of amoxicillin/clavulanate can vary from 1.5 to 4 g/day, with higher doses being more appropriate for patients with risk factors for infection with a resistant pathogen 1.
• The addition of clavulanate, a beta-lactamase inhibitor, protects the amoxicillin from being broken down by bacterial enzymes, thus overcoming the resistance mechanism.

Dosage and Administration

• The recommended dose of 4 g/250 mg per day can be divided into two doses, with the medication taken with food to reduce gastrointestinal side effects.
• Common side effects include diarrhea, nausea, and skin rash.
• The patient should complete the entire course of antibiotics even if symptoms improve before completion to prevent recurrence and antibiotic resistance.

Special Considerations

• If the patient has renal impairment, the dose may need adjustment based on creatinine clearance.
• The patient's response to the antibiotic should be closely monitored, and the treatment regimen may need to be adjusted if there is no improvement or if the patient's condition worsens.

From the FDA Drug Label

Table 3: Mean (±S.D.) Amoxicillin and Clavulanate Potassium Pharmacokinetic Parameters ... 250 mg/125 mg every 8 hours 500 mg/125 mg every 12 hours 500 mg/125 mg every 8 hours 875 mg/125 mg every 12 hours

The FDA drug label does not provide a specific dose for a patient who did not respond to amoxicillin. Dosing recommendations are provided for various regimens, but there is no direct information on how to dose amoxicillin-clavulanate in a patient who has not responded to amoxicillin alone 2.

• The label provides pharmacokinetic parameters for different doses and regimens of amoxicillin-clavulanate, but does not address the specific scenario of a patient who has not responded to amoxicillin.
• No conclusion can be drawn from the provided information regarding the appropriate dose of amoxicillin-clavulanate for this patient.

From the Research

Dose of Amoxicillin-Clavulanate

• The dose of amoxicillin-clavulanate for a 59-year-old male patient with a BMI of 27 who did not respond to amoxicillin is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the study by 4 mentions that amoxicillin-clavulanic acid is often used as empiric therapy for many infections, and the choice of combination ratio (e.g., 2:1,7:1,14:1, and 16:1) may vary depending on the region.
• It is also noted that clavulanic acid is more protein-bound and less heat-stable than amoxicillin, which may limit the maximum daily dose of amoxicillin that can be given in oral combination formulations 4.

Considerations for Treatment

• The study by 6 suggests that treatment with ceftriaxone/cefotaxime is not associated with lower in-hospital mortality than amoxicillin-clavulanate in patients hospitalized for community-onset pneumonia.
• Another study by 7 reviews the antimicrobial spectrum and potency of orally administered cephalosporins and amoxicillin/clavulanate, but does not provide specific dosing recommendations for amoxicillin-clavulanate.
• The study by 5 investigates the association between amoxicillin-clavulanate use and resistance to third-generation cephalosporins in Klebsiella pneumoniae and Escherichia coli, but does not address dosing specifically.

Available Information

• The provided studies do not offer direct guidance on the dose of amoxicillin-clavulanate for a patient who did not respond to amoxicillin 3, 4, 5, 6, 7.
• Further research or consultation of clinical guidelines may be necessary to determine the appropriate dose of amoxicillin-clavulanate for this patient.