What are the recommendations for?

From the Guidelines

I strongly recommend the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the first line of treatment for ankylosing spondylitis, considering the evidence from the ASAS/EULAR recommendations 1. When managing ankylosing spondylitis, it is essential to consider a multifaceted approach that includes pharmacological and non-pharmacological interventions.

• The use of NSAIDs, including conventional NSAIDs, coxibs, and co-prescription of gastroprotective agents, is supported by research evidence 1.
• Additionally, disease-modifying antirheumatic drugs, treatments with biological agents, simple analgesics, local and systemic steroids, and non-pharmacological treatments such as education, exercise, and physiotherapy may be considered based on individual patient needs and response to treatment.
• Surgical interventions may also be an option for patients with severe disease or those who have not responded to other treatments. The strength of recommendation for these interventions varies depending on the category of evidence and expert opinion, as outlined in the ASAS/EULAR recommendations 1.
• It is crucial to weigh the benefits and risks of each treatment option and to consider the individual patient's circumstances, such as comorbidities and concomitant medications.
• A comprehensive treatment plan should be developed in collaboration with the patient and a healthcare team, taking into account the latest evidence and guidelines, such as those provided by the ASAS/EULAR recommendations 1.

From the FDA Drug Label

The usual adult dose is one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 250 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hoursEvery 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a125 mg/5 mL or 250 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections45 mg/kg/day every 12 hours40 mg/kg/day every 8 hours Less severe infections25 mg/kg/day every 12 hours20 mg/kg/day every 8 hours

The recommended dosing regimens for amoxicillin-clavulanate (PO) are as follows:

• Adults: 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours for mild to moderate infections, and 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for more severe infections.
• Pediatric patients aged 12 weeks and older:
  • Otitis media, sinusitis, lower respiratory tract infections, and more severe infections: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours.
  • Less severe infections: 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours.
• Patients with renal impairment: dose adjustments are necessary for patients with severe renal impairment (GFR <30 mL/min) 2

From the Research

Recommendations for Amoxicillin/Clavulanate Usage

• Amoxicillin/clavulanate is a broad-spectrum antibacterial agent effective in treating community-acquired respiratory tract infections, including bacterial sinusitis, acute otitis media, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 3.
• The combination of amoxicillin and clavulanic acid is often used as empiric therapy for various infectious syndromes, but it is recommended to use amoxicillin alone when possible to minimize the risk of adverse reactions and the development of bacterial resistance 4, 5.
• High-dose formulations of amoxicillin/clavulanate, such as Augmentin XR and Augmentin ES-600, have been developed to treat drug-resistant pathogens, including Streptococcus pneumoniae with reduced susceptibility to penicillin 3.
• Amoxicillin/clavulanic acid in combination with an aminoglycoside, such as gentamicin, can be considered as an empirical antibiotic treatment in severe community-acquired infections with diagnostic uncertainty 6.

Safety and Efficacy Considerations

• Amoxicillin/clavulanate has a well-known safety and tolerance profile, but the clavulanate component may cause adverse reactions, including gastrointestinal side effects and Clostridium difficile infection 4, 5.
• The use of amoxicillin/clavulanate should be guided by epidemiological and pharmacokinetic data, as well as the availability of other effective antibiotic options 4.
• Patient self-management strategies, including education and problem-solving skills, can be an effective approach to managing chronic conditions and preventing complications 7.