What are the contraindications for Augmentin (amoxicillin and clavulanate) in patients, particularly those with a history of allergies or certain medical conditions?

Contraindications for Augmentin

Augmentin (amoxicillin/clavulanate) is absolutely contraindicated in two specific situations: patients with a history of serious hypersensitivity reactions (anaphylaxis or Stevens-Johnson syndrome) to amoxicillin, clavulanate, or other beta-lactam antibiotics, and patients with a previous history of cholestatic jaundice or hepatic dysfunction associated with amoxicillin/clavulanate use. 1

Absolute Contraindications

Serious Hypersensitivity Reactions

• Do not use Augmentin in patients with a history of anaphylaxis or Stevens-Johnson syndrome to amoxicillin, clavulanate, penicillins, or cephalosporins. 1
• This includes any serious hypersensitivity reaction to beta-lactam antibacterial drugs. 1

Previous Cholestatic Jaundice or Hepatic Dysfunction

• Augmentin is contraindicated in patients who have previously experienced cholestatic jaundice or hepatic dysfunction specifically associated with amoxicillin/clavulanate use. 1
• This is a unique contraindication to this specific combination, not just any antibiotic-related liver injury. 1

Critical Warnings and Precautions

Hypersensitivity Risk Assessment

• Before initiating Augmentin, carefully inquire about previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. 1
• Serious and occasionally fatal anaphylactic reactions have been reported with beta-lactam antibacterials, occurring more frequently in individuals with a history of penicillin hypersensitivity or multiple allergen sensitivities. 1
• If an allergic reaction occurs during treatment, discontinue Augmentin immediately and institute appropriate therapy. 1

Hepatic Monitoring Requirements

• Hepatic dysfunction, including hepatitis and cholestatic jaundice, has been associated with Augmentin use, with deaths reported despite usual reversibility. 1
• Monitor hepatic function at regular intervals in patients with pre-existing hepatic impairment. 1

Mononucleosis Exclusion

• Do not administer Augmentin to patients with mononucleosis, as a high percentage develop an erythematous skin rash. 1

Alternative Antibiotics for Clavulanate Allergy

When Augmentin is contraindicated due to clavulanate allergy:

• Cefdinir (14 mg/kg/day in 1-2 doses) is the preferred first-line alternative due to better patient acceptance and excellent coverage of common respiratory pathogens. 2
• Cefuroxime (30 mg/kg/day in 2 divided doses) provides comparable efficacy for respiratory tract infections. 2
• Cefpodoxime (10 mg/kg/day in 2 divided doses) is another effective third-generation cephalosporin with negligible cross-reactivity. 2

Important Caveat

• Verify the nature of the penicillin/clavulanate allergy before selecting alternatives, as many reported allergies are not true Type I hypersensitivity reactions. 2
• For non-severe or delayed-type reactions, cephalosporins can be safely used with low cross-reactivity rates. 2
• Avoid using macrolides or TMP/SMX as first-line alternatives due to high resistance rates (20-25% bacterial failure rates possible). 2