Is there a long‑acting liquid formulation of amoxicillin/clavulanate (Augmentin) that can be administered via a gastrostomy tube?

No Long-Acting Liquid Augmentin Formulation Exists

There is no long-acting liquid formulation of amoxicillin/clavulanate (Augmentin) available for administration via gastrostomy tube. The standard oral suspension requires reconstitution and dosing every 12 hours, with stability limited to 10 days under refrigeration 1.

Available Liquid Formulations

The FDA-approved liquid formulations of Augmentin include:

• Standard suspensions: 200 mg/28.5 mg per 5 mL and 400 mg/57 mg per 5 mL
• ES-600 suspension: 600 mg/42.9 mg per 5 mL (pediatric formulation)

All require twice-daily dosing (every 12 hours) 1.

G-Tube Administration Considerations

Practical Administration

• Standard Augmentin suspension can be administered via gastrostomy tube using appropriate technique
• The suspension must be shaken well before each use 1
• Administer at the start of a meal or with feeding to minimize GI intolerance and enhance clavulanate absorption 1
• Use a dosing syringe for accurate measurement and tube administration

Stability Limitations

• Once reconstituted, the suspension remains stable for only 10 days under refrigeration 1
• The suspension is not suitable for extended infusion through feeding tubes
• Recent stability data shows amoxicillin retains 90% concentration for only 5.9-8.8 hours at room temperature and 3.5-4.5 hours at body temperature (37°C) 2

Critical Tube Management

According to enteral nutrition guidelines, when administering medications via G-tube 3:

• Flush the tube before and after medication administration
• Avoid mixing medications with feeding formulas
• Monitor for tube occlusion, which can occur with viscous suspensions
• Ensure proper tube positioning and patency

Clinical Alternatives

Since no long-acting formulation exists, consider:

1. Standard twice-daily dosing with the available suspension formulations
2. Intravenous amoxicillin/clavulanate if oral/enteral route is inadequate for severe infections
3. Alternative antibiotics with once-daily dosing if medication adherence via G-tube is problematic (though this requires reassessing the specific infection and susceptibility patterns)

Common Pitfall

Do not attempt to prepare larger volumes for extended use beyond 10 days, as the antibiotic degrades and loses efficacy 1. The clavulanate component is particularly unstable and critical for the drug's activity against beta-lactamase-producing organisms 2.