Amoxicillin Clavulanate

PD Dialyzability: Very likely

Pharmacokinetic Parameters [1] [2]

  Amoxicillin Clavulanate
Molecular Weight (Da) 364 199
Plasma Protein Binding (%) 15 - 25 22 - 30
Volume of Distribution (L/Kg) 0.26 0.3 [3]
Hepatic Metabolism <30%, CYP2C19 Yes
Excreted Unchanged (%) 50 - 70 30 - 40
Half-Life; Normal Renal Function (hours) 0.9 - 2.3 1
Half-Life; ESRD (hours) 5 - 20 3 - 4 [3]

CAPD Dosing: [2] [3] [4] [5]

  • Amoxcillin clavulanate 250-500mg PO BID (Note: Dosing of amoxicillin/clavulanate combination is based mainly on the dosing of the amoxicillin portion)

CCPD Dosing:

  • One study identified. See literature summary below.

Literature Summary:

Title Patient Intervention Outcome Note
Peritonitis due to Rothia dentocariosa in a patient receiving continuous ambulatory peritoneal dialysis. [6]
  • CAPD
  • 66 year-old man
  • History of peritonitis
  • Admitted for fever and abdominal pain
  • TMP/SMX 160/800mg PO BID. patient developed thrombocytopenia and leukopenia after 4 days.
  • therapy switched to amoxi-clav 500/125mg PO TID plus amikacin 250mg IV Q48H for 14 day.
 Resolution of symptoms and fever. Catheter removed. Hemodialysis initiated. No ADR reported
Kocuria kristinae, an unusual cause of peritonitis in dialysis patients. [7]
  • CAPD
  • 78 year-old man
  • Admitted for fever and abdominal pain
  • Empiric therapy with cefotaxime IP + tobramycin IP + tazobactam IV
  • Day 6 - therapy adjusted based on C&S: ciprofloxacin IP + teicoplanin IP + amoxi-clav IV 2000mg BID
  • C&S guided therapy resulted in clinical improvement
  • Stepped down to ciprofloxacin 750mg po BID x 14 days on discharge (Day 16)
 Multiple antibiotic regimens employed
Helicobacter pylori infection: A new cause of anorexia in peritoneal dialysis patients. [8]
  • 48 PD patients (CAPD & APD) divided into four groups based on presence of anorexia and H. pylori infection
  • All given H.pylori treatment to assess impact on malnutrition status

10 days of:

  • Omeprazole 40mg PO daily
  • Clarithromycin 1g PO daily
  • Amoxicillin/Clavulanate 1000/250mg PO daily
 H pylori eradication improved patient’s appetite and nutritional status. No ADR reported

References

[1]Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(Database issue):D668-672.
[2](1, 2) American Pharmacists Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals. Hudson, Ohio; [Washington, D.C.: Lexi-Comp ; American Pharmacists Association; 2012.
[3](1, 2, 3) Gilbert B, Robbins P, Livornese LL. Use of Antibacterial Agents in Renal Failure. Medical Clinics of North America. 2011 Jul;95(4):677–702.
[4]Aronoff GR, editor. Drug prescribing in renal failure: dosing guidelines for adults and children. 5. ed. Philadelphia, Pa: American College of Physicians; 2007.
[5]Adjusting oral antibiotics to estimated creatinine clearance [Internet]. Vancouver: Vancouver Coastal Health. Clinical Services Unit Pharmaceutical Sciences Vancouver Acute.; 2013 [cited 1 December 2015].
[6]Bibashi E, Kokolina E, Mitsopoulos E, Kontopoulou K, Sofianou D. Peritonitis Due to Rothia dentocariosa in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis. Clinical Infectious Diseases. 1999 Mar;28(3):696–696.
[7]Carlini A, Mattei R, Lucarotti I, Bartelloni A, Rosati A. Kocuria kristinae: an unusual cause of acute peritoneal dialysis-related infection. Perit Dial Int. 2011 Feb;31(1):105–7.
[8]Aguilera A, Codoceo R, Bajo MA, Diéz JJ, del Peso G, Pavone M, et al. Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients. Perit Dial Int. 2001;21 Suppl 3:S152-156.