Disease relevance of Clavulin

• Double-blind randomised trial of co-amoxiclav versus placebo for persistent otitis media with effusion in general practice [1].
• However, co-amoxiclav cannot be routinely recommended for pPROM because of its association with neonatal necrotising enterocolitis [2].
• We have assessed the efficacy of co-amoxiclav in patients with common colds but no clinical signs of sinusitis or other indications for antibiotics [3].
• A blood-culture isolate of Bacteroides fragilis, taken from a woman after elective laparotomy, was resistant to metronidazole and had reduced susceptibility to imipenem and co-amoxiclav [4].
• In vitro activities of co-amoxiclav at concentrations achieved in human serum against the resistant subpopulation of heteroresistant Staphylococcus aureus: a controlled study with vancomycin [5].

Psychiatry related information on Clavulin

• In particular, since good patient compliance is a key factor in the successful treatment of any infection, the once daily treatment with prulifloxacin may have some compliance advantages compared to the twice-daily treatment with agents such as ciprofloxacin or co-amoxiclav [6].

High impact information on Clavulin

• Improved phagocyte response by co-amoxiclav in renal transplant recipients [7].
• METHODS: The influence of co-amoxiclav on the functions of polymorphonuclear granulocytes (PMNs) from renal transplant recipients were investigated [7].
• When PMNs were collected from renal transplant recipients treated with co-amoxiclav a significant high increase in both phagocytosis and killing activity were detected, showing the co-amoxiclav capability of "restoring" even in vivo the depressed primary functions of PMNs [7].
• Co-amoxiclav levels in bronchial mucosa [8].
• OBJECTIVES: We conducted a prospective pharmacokinetic study of oral co-amoxiclav in patients with melioidosis to determine the optimal dosage and dosing interval in this potentially fatal infection [9].

Chemical compound and disease context of Clavulin

• Although co-amoxiclav only and co-amoxiclav plus erythromycin were associated with prolongation of pregnancy, they were also associated with a significantly higher rate of neonatal necrotising enterocolitis [2].
• Efficacy, safety and tolerability of 3 day azithromycin versus 10 day co-amoxiclav in the treatment of children with acute lower respiratory tract infections [10].
• Seven laboratories, including a reference laboratory, tested the susceptibility of Moraxella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae strains to ciprofloxacin, clarithromycin, co-amoxiclav and sparfloxacin with the Etest [11].
• Resistance to ampicillin as well as co-amoxiclav never exceeded 7% in Salmonella enteritidis [12].
• The effects of co-amoxiclav (AMC) and amoxicillin (AMX) therapy on the nasopharyngeal flora of children with acute otitis media (AOM) were compared [13].

Biological context of Clavulin

• Co-amoxiclav pharmacokinetics during posttraumatic hemorrhagic shock [14].
• Data were obtained from plasma concentration-time curves from four different open, randomized, two-treatment, two-period, two-sequence, crossover Phase I bioequivalence studies, with the following co-amoxiclav formulations: tablets 250/125, 500/125 and 875/125 mg, or 10 mL of an oral suspension 250/62.5 mg per 5 mL [15].
• Bacteriological success in the bacteriology PP population at follow-up was 85.0% (17/20) for co-amoxiclav 2000/125 mg versus 77.3% (17/22) for co-amoxiclav 875/125 mg (TD = 7.7%, 95% CI: 15.8, 31.2) [16].
• OBJECTIVES: We studied the clonal relatedness, in terms of phylogenetic group, virulence factors and co-amoxiclav resistance, of different Escherichia coli isolates obtained from blood and urine of a patient who had taken a 45 day course of co-amoxiclav [17].
• One positive PCR result was not supported by positive treponemal serology (this patient coincidentally received a 10 day course of co-amoxiclav 1 week after sampling) [18].

Anatomical context of Clavulin

• High-dosage co-amoxiclav in a single dose versus 7 days of co-trimoxazole as treatment of uncomplicated lower urinary tract infection in women [19].
• Only after high dose co-amoxiclav did the concentration in the middle ear exceed the MIC by a factor of four [20].
• Co-amoxiclav also affects endothelial cells [21].
• The effect of antimicrobial therapy with amoxycillin (AMX) or co-amoxiclav (AMC) on the adenoid bacterial flora of 45 children with recurrent otitis media (ROM), scheduled for elective adenoidectomy, was studied [22].
• Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract [23].

Associations of Clavulin with other chemical compounds

• The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB [24].
• The minimum inhibitory concentrations (MICs) of cefaclor, co-amoxiclav, clarithromycin and ciprofloxacin for 59 strains of vaginal lactobacilli were determined by both the reference agar dilution and E test methods [25].
• The in vitro activity of faropenem, an oral penem, was compared with those of penicillin, co-amoxiclav, cefoxitin, clindamycin, erythromycin and metronidazole against 106 isolates of anaerobic pathogens involved in systemic infections [26].
• For the penicillin-insensitive strain (MIC/MBC = 1/2 mg/L), the minimum dosage tested giving significant cure was 50 mg/kg for amoxycillin and co-amoxiclav but 100 mg/kg for cefotaxime [27].
• Patients were randomized to receive either placebo or 2.2 g co-amoxiclav (or 2 g cefotaxime if penicillin-allergic) at time of percutaneous endoscopic gastrostomy insertion [28].

Gene context of Clavulin

• Tazobactam and clavulanate inhibit the enzyme, but beta-lactamase producers remained substantially less susceptible than non-producers to piperacillin/tazobactam and co-amoxiclav in disc tests [29].
• All MRSA isolates were resistant to co-amoxiclav, ciprofloxacin, clarithromycin, gentamicin, methicillin, norfloxacin, ofloxacin, oxacillin and polymyxin B [30].
• Despite a normal beta-lactamase activity, the two remaining E. coli strains and their derivatives were less susceptible to co-amoxiclav [31].
• Six isolates (one type b from CSF) were resistant to all drugs tested, except for co-amoxiclav [32].
• When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance [23].

Analytical, diagnostic and therapeutic context of Clavulin

• The in vitro susceptibilities suggest that clinical trials to treat enteritis caused by multidrug-resistant C. jejuni with co-amoxiclav, and life-threatening infections with a carbapenem, may be valuable [33].
• METHODS: This randomized, double-blind, double-dummy, multicentre study compared the efficacy and safety of oral co-amoxiclav 2000/125 mg twice daily versus co-amoxiclav 875/125 mg three times daily, for 7 or 10 days, in the treatment of community-acquired pneumonia (CAP) [16].
• The efficacy and safety of a three-day regimen of azithromycin (500 mg od) and a ten-day regimen of co-amoxiclav (625 mg tid) were compared in a single-blind study in 99 patients with acute lower respiratory tract infections [34].
• METHODS: An open Phase I study measuring ex vivo bactericidal activity after anti-pneumococcal vaccination and an oral dose of 2000/125 mg sustained-release co-amoxiclav was carried out [35].
• Five patients failed on co-amoxiclav, whereas their S. pneumoniae were susceptible to penicillin and amoxicillin.This observation suggests that macrolide resistance is clinically relevant and leads to treatment failure, whereas suboptimal dosing may explain breakthrough pneumococcal bacteraemia in beta-lactam-treated patients [36].

References