From the Research
Amoxicillin-clavulanate should be used with caution in patients with myasthenia gravis, but it is not absolutely contraindicated. Patients with myasthenia gravis may experience worsening of their symptoms when taking this antibiotic due to its potential neuromuscular blocking effects, as reported in a case series where six patients with myasthenia gravis developed acute worsening of symptoms after amoxicillin or amoxicillin/clavulanate treatment 1. If prescribed, healthcare providers should monitor these patients closely for signs of respiratory difficulty, increased muscle weakness, or exacerbation of myasthenia symptoms.
Key Considerations
- Alternative antibiotics without known neuromuscular effects might be preferred when appropriate based on the infection being treated.
- The mechanism behind this interaction involves the clavulanic acid component potentially interfering with neuromuscular transmission, which is already compromised in myasthenia gravis patients.
- If amoxicillin-clavulanate must be used due to the specific infection profile, starting with lower doses and gradually increasing while monitoring for adverse effects may be a reasonable approach, as suggested by the need for careful management of patients with myasthenia gravis 2, 3, 4, 5.
- Patients should be educated to report any worsening of their myasthenia symptoms immediately.
Clinical Approach
Given the potential risks, a cautious approach is warranted. This includes:
- Close monitoring of patients for signs of worsening myasthenia gravis symptoms.
- Consideration of alternative antibiotics that do not have neuromuscular blocking effects.
- Patient education on the potential risks and the importance of reporting any increase in symptoms.
- A multidisciplinary approach to manage myasthenia gravis, including neurologists, primary care physicians, and other healthcare professionals, to ensure comprehensive care and minimize risks associated with antibiotic use 1.