Penicillin + Beta-Lactamase Inhibitor·Infectious Diseases - Penicillins

Amoxicillin/clavulanate

Bite wounds, severe exacerbations of COPD, diabetic foot infections

Authority requiredPBSBETA-LACTAMAugmentin, CuramS4+1

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At a glance

Max Dose

875/125 mg BD

Half-life

1 h

Caution: Hepatotoxicity

HIGH RISK

Caution: Diarrhea

COMMON

Cautions

Avoid / Cautions

History of Augmentin-associated jaundice/hepatic dysfunction or severe penicillin allergy. Pregnancy Category B1 (Generally safe, but avoid close to term due to theoretical necrotising enterocolitis risk in neonate).

Where it stands

Rapid Summary

Overview

Amoxicillin paired with clavulanic acid to overcome beta-lactamase producing bacteria. The go-to for animal/human bites and mixed intra-abdominal infections.

Clinical Focus

The clavulanate component is notoriously hepatotoxic. Avoid courses longer than 10-14 days.

Bottom Line

Amoxicillin/clavulanate is the standard beta-lactamase-stable penicillin for resistant RTIs, UTIs, and bite wounds, but the clavulanate component frequently causes diarrhoea and hepatotoxicity risk increases with prolonged use.

Formulation & Access

Brand Names

Augmentin, Curam

Oral Routes

Tablets (500/125 mg, 875/125 mg).

Parenteral

Ampoule (1 g/200 mg) for IV use.

Prescribing & PBS

Authority Required (PBS) for specific indications.

Indications & Use

Primary

PBSTGA

Bite wounds, severe exacerbations of COPD, diabetic foot infections.

Clinical Place

Essential step-up when beta-lactamase resistance is suspected (e.g., H. influenzae, M. catarrhalis, S. aureus).

Quick reference

Class & Role

Penicillin + Beta-Lactamase Inhibitor — Amoxicillin paired with clavulanic acid to overcome beta-lactamase producing bacteria.

Route / Formulation

Tablets (500/125 mg, 875/125 mg). (Augmentin, Curam)

Usual Dose & Max

PO 500/125 mg BD or TDS. Max 875/125 mg BD (Oral).

Key Indication Doses

Animal / Human Bites: PO 500/125 mg BD or TDS. Severe Respiratory / Intra-abdominal: PO 875/125 mg BD. OR IV 1.2 g q8h. Renal Impairment: Avoid the 875/125 mg tablet if eGFR < 30. Use 500/125 mg instead.

Best Uses

Key Risks

Hepatic: Cholestatic jaundice and hepatitis. Risk increases sharply with age and courses > 14 days. Gastrointestinal: Severe diarrhea, nausea, C. difficile infection. Immunological: Anaphylaxis (cross-reactive with all penicillins).

Key Interactions

Increases toxicity of Methotrexate (reduced renal clearance). Can prolong INR in patients on Warfarin.

Monitoring

Monitor LFTs if therapy extends beyond 7-10 days. Warn patients to report dark urine, pale stools, or yellow sclera even *after* stopping the drug.

Clinical Pearl

If you need more amoxicillin, add plain amoxicillin. Never prescribe Augmentin 'TDS' if using the 875/125mg tablets—doubling the dose doubles the clavulanate, triggering massive diarrhea and severe hepatotoxicity.

Access

Authority requiredAugmentin, Curam

Brand: Augmentin, Curam
PBS status: Authority required
Formulation: Tablets (500/125 mg, 875/125 mg).

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