Drug interaction

Oral anticoagulants and penicillin antibiotics are widely used in clinical practice without reports of their interaction. However, the literature describes cases of an increase in INR in patients with the combined use of acenocoumarol or warfarin and amoxicillin. If necessary, the simultaneous use of prothrombin time or INR should be carefully monitored when prescribing or canceling amoxicillin. In addition, a dose adjustment of oral anticoagulants may be required..

Penicillins may decrease methotrexate excretion, leading to a potential increase in toxicity.

Augmentin ® is not recommended to be used simultaneously with probenecid. Probenecid reduces the tubular secretion of amoxicillin, and therefore the simultaneous use of the drug Augmentin ® and probenecide can lead to a steady and long-term increase in the blood concentration of amoxicillin, but not clavulanic acid.

In patients receiving mycophenolate mofetil, after the start of oral administration of a combination of amoxicillin with clavulanic acid, a decrease in the concentration of the active metabolite, mycophenolic acid, was observed before taking the next dose of the drug by about 50%. Changes in this concentration cannot accurately reflect the general changes in the exposure of mycophenolic acid. In this regard, as a rule, dose adjustment of mycophenolate mofetil is not required in the absence of clinical signs of impaired graft function. However, careful clinical monitoring should be carried out while taking a combination of drugs, as well as soon after the end of antibiotic treatment.

Types of exacerbation of chronic bronchitis

Depending on the clinic, 3 types of exacerbation are distinguished.

The first type of exacerbation of chronic bronchitis is characterized by increased shortness of breath, an increase in the volume of secreted sputum of a purulent nature.

If there are only two symptoms mentioned above, this is the second type of exacerbation.

With the third type of exacerbation of bronchitis, the pulse rate increases.

The third type of exacerbation is a condition when one of the three signs of the first type is combined with one of the following symptoms:

  • upper respiratory tract infection for five days;
  • fever caused by a disease;
  • increase and amplification of dry wheezing;
  • increased and increased coughing;
  • increase in respiratory rate by 20% compared with the usual state;
  • 20% increase in heart rate in the main arteries (or the number of heart contractions) compared with the usual state.

Stages of the disease

All morphological changes in the lungs as a result of the development of pathology are conditionally divided into 4 stages:

  1. The first stage is the tide. At this time, microbial edema develops. Stage duration - about a day.
  2. Stage two - the gradual defeat of the entire lung: the organ grows in volume, becomes loose and airless. On the pleura, spotted outflows and gray-white plaque are formed..
  3. The third stage - on 4-6 days, the red shade of the lobe of the lung acquires a gray color. In the alveoli exudate increases.
  4. The fourth stage is the resolution of the disease. This stage is formed on days 9-12.

pharmachologic effect

Amoxicillin is a semi-synthetic broad-spectrum antibiotic with activity against many gram-positive and gram-negative microorganisms. At the same time, amoxicillin is susceptible to destruction by beta-lactamases, and therefore the spectrum of activity of amoxicillin does not extend to microorganisms that produce this enzyme. Clavulanic acid, a beta-lactamase inhibitor structurally related to penicillins, has the ability to inactivate a wide range of beta-lactamases found in penicillin and cephalosporin resistant microorganisms. Clavulanic acid is sufficiently effective against plasmid beta-lactamases, which are most often responsible for bacterial resistance, and is less effective against chromosomal beta-lactamases of the 1st type, which are not inhibited by clavulanic acid. The presence of clavulanic acid in the Augmentin preparation protects amoxicillin from destruction by enzymes - beta-lactamases, which allows to expand the antibacterial spectrum of amoxicillin.

The following is the in vitro combination activity of amoxicillin with clavulanic acid (order augmentin). Pharmacokinetics

Absorption Both active ingredients of the Augmentin preparation - amoxicillin and clavulanic acid - are quickly and completely absorbed from the gastrointestinal tract after oral administration. The absorption of the active substances of the drug Augmentin is optimal in case of taking the drug at the beginning of a meal.

Distribution As with the iv administration of a combination of amoxicillin with clavulanic acid, therapeutic concentrations of amoxicillin and clavulanic acid are found in various tissues and interstitial fluid (gall bladder, abdominal tissues, skin, fat and muscle tissue, synovial and peritoneal fluids, bile, purulent detachable). Amoxicillin and clavulanic acid have a weak degree of binding to plasma proteins. Studies have shown that about 25% of the total amount of clavulanic acid and 18% of amoxicillin in blood plasma binds to blood plasma proteins. In animal studies, no cumulation of the components of the Augmentin® preparation in any organ was found. Amoxicillin, like most penicillins, passes into breast milk. Traces of clavulanic acid may also be found in breast milk. Except for the possibility of developing diarrhea and candidiasis of the mucous membranes of the oral cavity, no other negative effects of amoxicillin and clavulanic acid on the health of breast-fed infants are known. Animal reproductive studies have shown that amoxicillin and clavulanic acid cross the placental barrier. However, no adverse effects on the fetus were detected. Metabolism 10-25% of the initial dose of amoxicillin is excreted by the kidneys in the form of an inactive metabolite (penicilloic acid). Clavulanic acid is extensively metabolized to 2,5-dihydro-4- (2-hydroxyethyl) -5-oxo-3H-pyrrole-3-carboxylic acid and amino-4-hydroxy-butan-2-one and excreted via the kidneys Gastrointestinal tract, as well as with expired air in the form of carbon dioxide. Excretion Like other penicillins, amoxicillin is excreted mainly by the kidneys, while clavulanic acid is excreted by both the renal and extrarenal mechanisms. About 60–70% of amoxicillin and about 40–65% of clavulanic acid are excreted by the kidneys unchanged in the first 6 hours after taking 1 table. 250 mg + 125 mg or 1 tablet 500 mg + 125 mg. The simultaneous administration of probenecid slows the excretion of amoxicillin, but not clavulanic acid (see “Interaction”).


Both active ingredients of the drug Augmentin, amoxicillin and clavulanic acid, are rapidly and completely absorbed from the gastrointestinal tract (GIT) after oral administration. http://idmp.ucsf.edu/maximum-dosing-amoxicillin-and-amoxicillin-clavulanate The absorption of the active ingredients of the Augmentin® preparation is optimal when taking the drug at the beginning of a meal.