Amoxicillin and Clavulanate Potassium description, usages, side effects, indications, overdosage, supplying and lots more!

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Amoxicillin and Clavulanate Potassium

Aurobindo Pharma Limited


FULL PRESCRIBING INFORMATION: CONTENTS*




FULL PRESCRIBING INFORMATION


AMOXICILLIN AND CLAVULANATE POTASSIUM DESCRIPTION


SRRRp
Amoxicillin and Clavulanate Potassium
Streptomyces clavuligerus-ZRR
Amoxicillin and Clavulanate Potassium



Inactive Ingredients:

PRECAUTIONS, Information for the Patient, Phenylketonurics

CLINICAL PHARMACOLOGY


Table 1. Mean (±SD) Plasma Amoxicillin and Clavulanate Pharmacokinetic Parameter Values Following Administration of 45 mg/kg of Amoxicillin and Clavulanate Potassium for Oral Suspension, 600 mg/42.9 mg per 5 mL Every 12 Hours to Pediatric Patients
Parameter* Amoxicillin Clavulanate
*Arithmetic mean ± standard deviation, except Tmax values which are medians (ranges).
   Cmax (mcg/mL)
15.7 ± 7.7
1.7 ± 0.9
   Tmax (hr)
2 (1 to 4)
1.1 (1 to 4)
   AUC0-t (mcghr/mL)
59.8 ± 20
4 ± 1.9
   T½ (hr)
1.4 ± 0.3
1.1 ± 0.3
   CL/F (L/hr/kg)
0.9 ± 0.4
1.1 ± 1.1










Table 2. Amoxicillin Concentrations in Plasma and Middle Ear Fluid Following Administration of 45 mg/kg of Amoxicillin and Clavulanate Potassium for Oral Suspension, 600 mg/42.9 mg per 5 mL to Pediatric Patients
Timepoint
Amoxicillin concentration
in plasma (mcg/mL)
Amoxicillin concentration
in MEF (mcg/mL)
   1 hour
mean
median
range
7.7
9.3
1.5 to 14
(n = 5)
3.2
3.5
0.2 to 5.5
(n = 4)
   2 hour
mean
median
range
15.7
13
11 to 25
(n = 7)
3.3
2.4
1.9 to 6
(n = 5)
   3 hour
mean
median
range
13
12
5.5 to 21
(n = 5)
5.8
6.5
3.9 to 7.4
(n = 5)



Microbiology






in vitro INDICATIONS AND USAGE

Aerobic Gram-Positive Microorganisms

 
Streptococcus pneumoniae

Aerobic Gram-Negative Microorganisms

 
Haemophilus influenzae
Moraxella catarrhalis

in vitro but their clinical significance is unknown.

in vitro

Aerobic Gram-Positive Microorganisms


Staphylococcus aureus


NOTE:


Streptococcus pyogenes


NOTE:
S. pyogenesS. pyogenes

Susceptibility Test Methods


in vitro

Dilution Technique


1,2 S. pneumoniaeH. influenzae

Table 3

Diffusion Technique



2,3Table 3
Table 3. Susceptibility Test Result Interpretive Criteria for Amoxicillin/Clavulanate Potassium
Pathogen Minimum Inhibitory Concentration (mcg/mL) Disk Diffusion
(Zone Diameter in mm)
S I R S I R
   Streptococcus pneumoniae (non-meningitis isolates)
≤ 2/1
4/2
≥ 8/4
Not applicable (NA)
   Haemophilus influenzae
≤ 4/2
NA
≥ 8/4
≥ 20
NA
≤ 19

NOTE:S. pneumoniaeS. pneumoniae

NOTE:
H. influenzae



1-3Table 4.Table 4
Table 4. Acceptable Quality Control Ranges for Amoxicillin/Clavulanate Potassium
*ATCC is a trademark of the American Type Culture Collection.
When using Haemophilus Test Medium (HTM).
Quality Control Organism
Minimum Inhibitory Concentration Range (mcg/mL)
Disk Diffusion (Zone Diameter Range in mm)
   Escherichia coli ATCC®* 35218
   (H. influenzae quality control)
4/2 to 16/8
17 to 22
   Haemophilus influenzae ATCC 49247
2/1 to 16/8
15 to 23
   Streptococcus pneumoniae ATCC 49619
0.03/0.016 to 0.12/0.06
NA

AMOXICILLIN AND CLAVULANATE POTASSIUM INDICATIONS AND USAGE


S. pneumoniaeH. influenzae M. catarrhalis
  • antibiotic exposure for acute otitis media within the preceding 3 months, and either of the following:
    • age ≤ 2 years
    • daycare attendance

CLINICAL PHARMACOLOGY, Microbiology

NOTE:
S. pneumoniae S. pneumoniae

S. pneumoniae

AMOXICILLIN AND CLAVULANATE POTASSIUM CONTRAINDICATIONS


WARNINGS


SERIOUS ANAPHYLACTIC REACTIONS REQUIRE IMMEDIATE EMERGENCY TREATMENT WITH EPINEPHRINE. OXYGEN, INTRAVENOUS STEROIDS, AND AIRWAY MANAGEMENT, INCLUDING INTUBATION, SHOULD ALSO BE ADMINISTERED AS INDICATED.

Clostridium difficileC. difficile

C. difficile
C. difficile

C. difficileC. difficile

CONTRAINDICATIONS  ADVERSE REACTIONS, Liver

PRECAUTIONS

General






PseudomonasCandida

Information for the Patient








Phenylketonurics


Drug Interactions








Drug/Laboratory Test Interactions


®®

.

Carcinogenesis, Mutagenesis, Impairment of Fertility


in vitroin vivoin vitro

Teratogenic Effects


Pregnancy (Category B)

Labor and Delivery


Nursing Mothers


Pediatric Use


DESCRIPTION OF CLINICAL STUDIES

CLINICAL PHARMACOLOGY

AMOXICILLIN AND CLAVULANATE POTASSIUM ADVERSE REACTIONS






Gastrointestinal

WARNINGS

Hypersensitivity Reactions

WARNINGS

Liver


CONTRAINDICATIONS

Renal

OVERDOSAGE

Hemic and Lymphatic Systems
 


Central Nervous System



Miscellaneous

OVERDOSAGE




4





AMOXICILLIN AND CLAVULANATE POTASSIUM DOSAGE AND ADMINISTRATION


Amoxicillin and clavulanate potassium for oral suspension, 600 mg/42.9 mg per 5 mL, does not contain the same amount of clavulanic acid (as the potassium salt) as any of the other amoxicillin and clavulanate potassium suspensions. Amoxicillin and clavulanate potassium for oral suspension, 600 mg/42.9 mg per 5 mL contains 42.9 mg of clavulanic acid per 5 mL, whereas the amoxicillin and clavulanate potassium, 200 mg/28.5 mg per 5 mL suspension contains 28.5 mg of clavulanic acid per 5 mL and the 400 mg/57 mg per 5 mL suspension contains 57 mg of clavulanic acid per 5 mL. Therefore, the amoxicillin and clavulanate potassium 200 mg/28.5 mg per 5 mL and 400 mg/57 mg per 5 mL suspensions should not be substituted for amoxicillin and clavulanate potassium for oral suspension, 600 mg/42.9 mg per 5 mL, as they are not interchangeable.

Dosage


Pediatric patients 3 months and older

Body Weight
(kg)
Volume of Amoxicillin and Clavulanate
Potassium for Oral Suspension,
600 mg/42.9 mg per 5 mL providing
90 mg/kg/day
8
3 mL twice daily
12
4.5 mL twice daily
16
6 mL twice daily
20
7.5 mL twice daily
24
9 mL twice daily
28
10.5 mL twice daily
32
12 mL twice daily
36
13.5 mL twice daily

Pediatric patients weighing 40 kg and more



Adults




WARNINGS

Directions for Mixing Oral Suspension



Amoxicillin and Clavulanate Potassium for Oral Suspension, 600 mg/42.9 mg per 5 mL
Bottle Size
Amount of Water
Required for Reconstitution
75 mL
71 mL
125 mL
112 mL
200 mL
176 mL



NOTE:

Administration


HOW SUPPLIED


Amoxicillin and Clavulanate Potassium for Oral Suspension USP, 600 mg/42.9 mg per 5 mL





STORAGE


DESCRIPTION OF CLINICAL STUDIES




S. pneumoniaeS. pneumoniaeTable 5

Table 5. Bacteriologic Eradication Rates in the Per Protocol Population
Bacteriologic Eradication on Therapy
Pathogen n/N % 95% CI*
* CI = confidence intervals; 95% CIs are not adjusted for multiple comparisons.
   All S. pneumoniae
121/123
98.4
(94.3, 99.8)
   S. pneumoniae with penicillin MIC = 2 mcg/mL
19/19
100
(82.4, 100)
   S. pneumoniae with penicillin MIC = 4 mcg/mL
12/14
85.7
(57.2, 98.2)
   H. influenzae
75/81
92.6
(84.6, 97.2)
   M. catarrhalis
11/11
100
(71.5, 100)



Table 6. Clinical Assessments in the Per Protocol Population (Includes S. pneumoniae Patients With Penicillin MICs = 2 or 4 mcg/mL*)
2 to 4 Days Post-Therapy
(Primary Endpoint)
Pathogen n/N % 95% CI†
* S. pneumoniae strains with penicillin MICs of 2 or 4 mcg/mL are considered resistant to penicillin.
CI = confidence intervals; 95% CIs are not adjusted for multiple comparisons.
Clinical assessments at 15 to 18 days post-therapy may have been confounded by viral infections and new episodes of acute otitis media with time elapsed post-treatment.
   All S. pneumoniae
122/137
89.1
(82.6, 93.7)
   S. pneumoniae with penicillin MIC = 2 mcg/mL
17/20
85
(62.1, 96.8)
   S. pneumoniae with penicillin MIC = 4 mcg/mL
11/14
78.6
(49.2, 95.3)
   H. influenzae
141/162
87
(80.9, 91.8)
   M. catarrhalis
22/26
84.6
(65.1, 95.6)
 
15 to 18 Days Post-Therapy
(Secondary Endpoint)
Pathogen
n/N
%
95% CI
   All S. pneumoniae
95/136
69.9
(61.4, 77.4)
   S. pneumoniae with penicillin MIC = 2 mcg/mL
11/20
55
(31.5, 76.9)
   S. pneumoniae with penicillin MIC = 4 mcg/mL
5/14
35.7
(12.8, 64.9)
   H. influenzae
106/156
67.9
(60, 75.2)
   M. catarrhalis
14/25
56
(34.9, 75.6)

S. pneumoniae



REFERENCES

 

  • Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing – 21st Informational Supplement. CLSI Document M100-S21. CLSI, 940 West Valley Rd., Suite 1400, Wayne, PA 19087, 2011.
  • Clinical and Laboratory Standards Institute (CLSI). Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria – Approved Standard 7th ed. CLSI Document M11-A7. CLSI, 940 West Valley Rd., Suite 1400, Wayne, PA 19087, 2007.
  • Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard – 8th ed. CLSI Document M07-A8. CLSI, 940 West Valley Rd., Suite 1400, Wayne, PA19087, 2009.
  • Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Test; Approved Standard – 10th ed. CLSI Document M02-A10. CLSI, 940 West Valley Rd., Suite 1400, Wayne, PA 19087, 2009.
  • Swanson-Biearman B, Dean BS, Lopez G, Krenzelok EP. The effects of penicillin and cephalosporin ingestions in children less than six years of age. Vet Hum Toxicol. 1988;30:66-67.

®
®


Aurobindo Pharma USA, Inc.




Aurobindo Pharma Limited


PACKAGE LABEL-PRINCIPAL DISPLAY PANEL - 600 mg/42.9 mg per 5 mL (200 mL Bottle)


NDC 65862-535-02
Amoxicillin and Clavulanate
Potassium for Oral Suspension, USP

600 mg/42.9 mg* per 5 mL
Rx only
200 mL when reconstituted
AUROBINDO
Amoxicillin and Clavulanate Potassium

Amoxicillin and Clavulanate Potassium

Amoxicillin and Clavulanate Potassium POWDER, FOR SUSPENSION

Product Information

Product Type Human prescription drug label Item Code (Source) NDC:65862-535
Route of Administration ORAL DEA Schedule

Active Ingredient/Active Moiety

Ingredient Name Basis of Strength Strength
AMOXICILLIN amoxicillin anhydrous 600 mg
CLAVULANATE POTASSIUM clavulanic acid 42.9 mg

Inactive Ingredients

Ingredient Name Strength
ASPARTAME
COLLOIDAL SILICON DIOXIDE
HYPROMELLOSE 2910 (50 MPA.S)
SILICON DIOXIDE
SUCCINIC ACID
XANTHAN GUM
Strawberry

Product Characteristics

Color
WHITE (White to Off-white)

Packaging

# Item Code Package Description Marketing Start Date Marketing End Date
1 NDC:65862-535-75 75 in 1 BOTTLE
2 NDC:65862-535-13 125 in 1 BOTTLE
3 NDC:65862-535-02 200 in 1 BOTTLE

Marketing Information

Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA201091 2011-12-20


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