ArticleBMC pharmacology & toxicology2014
Is the standard dose of amoxicillin-clavulanic acid sufficient?
Article in BMC pharmacology & toxicology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Scaling beta-lactam antimicrobial pharmacokinetics from early life to old age.British journal of clinical pharmacology · 2019Pooled it
- Pharmacokinetics of Oral Amoxicillin for the Treatment of Syphilis in Pregnancy.Open forum infectious diseases · 2026Trial
- Optimising Regimen of Co-Amoxiclav (ORCA)-The Safety and Efficacy of Intravenous Co-Amoxiclav at Higher Dosing Frequency in Patients with Diabetic Foot Infection.Antibiotics (Basel, Switzerland) · 2025Article
- Optimizing β-lactam-containing antibiotic combination therapy for the treatment of Buruli ulcer.British journal of clinical pharmacology · 2025Article
- Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Intradiscal pharmacokinetics of oral antibiotics to treat Chronic Lower Back Pain.npj antimicrobials and resistance · 2023Review
- Individualized antibiotic dosage regimens for patients with augmented renal clearance.Frontiers in pharmacology · 2023Review
- Steering Away from Current Amoxicillin Dose Reductions in Hospitalized Patients with Impaired Kidney Function to Avoid Subtherapeutic Drug Exposure.Antibiotics (Basel, Switzerland) · 2022Article
- Increased β-Lactams dosing regimens improve clinical outcome in critically ill patients with augmented renal clearance treated for a first episode of hospital or ventilator-acquired pneumonia: a before and after study.Critical care (London, England) · 2019Article
- Effect of Environment on the Evolutionary Trajectories and Growth Characteristics of Antibiotic-ResistantFrontiers in microbiology · 2019Article
- Drug therapy management in patients with renal impairment: how to use creatinine-based formulas in clinical practice.European journal of clinical pharmacology · 2016Article
- Cefotaxime and Amoxicillin-Clavulanate Synergism against Extended-Spectrum-β-Lactamase-Producing Escherichia coli in a Murine Model of Urinary Tract Infection.Antimicrobial agents and chemotherapy · 2016Article
- Augmented renal clearance implies a need for increased amoxicillin-clavulanic acid dosing in critically ill children.Antimicrobial agents and chemotherapy · 2015Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe pharmacodynamic (PD) efficacy target of amoxicillin is 40% time above the minimal inhibition concentration (40%T > MIC). Recent studies of other antibiotics have shown that PD-efficacy targets are not always reached. The aim of this study was to evaluate the percentage of hospitalised patients, using amoxicillin/clavulanic acid intravenously (iv), that reach the pharmacodynamic efficacy target 40%T > MIC. Additionally, the association of demographic anthropomorphic and clinical parameters with the pharmacokinetics and pharmacodynamics of amoxicillin were determined.
methodsIn serum of 57 hospitalised patients amoxicillin concentrations were measured using high performance liquid chromatography. Patients were older than 18 years and most patients had an abdominal infection. The standard amoxicillin/clavulanic acid dose was 4 times a day 1000/200 mg iv. Pharmacokinetic parameters were calculated with maximum a posteriori Bayesian estimation (MW\Pharm 3.60). A one-compartment open model was used. Individual dosing simulations were performed with MW\Pharm.
resultsIn our study population, the mean (±SD) age was 67 (±16) years and the mean clearance corrected for bodyweight was 0.17 (±0.07) L/h/kg. Only, 65% of the patients reached the proposed amoxicillin 40%T > MIC with amoxicillin/clavulanic acid for bacterial MICs of 8 mg/L. A computer simulated increase of the standard dose to 6 times daily, increased this percentage to 95%. In this small study group 40%T > MIC was not associated with clinical or microbiological cure.
conclusionA substantial proportion of the hospitalised patients did not reach the 40%T > MIC with the standard dose amoxicillin/clavulanic acid for a bacterial MIC of 8 mg/L. Therefore, we suggest increasing the standard dose of amoxicillin/clavulanic acid to 6 times a day in patients with severe Enterobacteriaceae infections.
trial registrationTRIAL REGISTRATION NUMBER: NTR1725 16th march 2009.
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