E-drug: Amoxycillin/clavulanic acid (3)
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Following on Joel Lexchin's report on availability of
amoxycillin/clavulanic acid (co-amoxy-clav) in Canada, the following
is the Australian situation:
The drug is available on (subsidised by) the Pharmaceutical Benefits
Scheme, but is restricted. The wording of the restriction is
'infections where resistance to amoxycillin is suspected or proven'.
The wording also warns against liver toxicity with this agent. We are
not sure of the effects of the restriction.
Following warnings of liver damage and feedback to the highest
prescribers of co-amoxy-clav by the Health Insurance Commission there
was an overall fall in use in 1995/96.
The Australian antibiotic guidelines (I am using Edition 9) also
express similar reservations and seem to be tougher on the drug than
the Canadian Guidelines:
Taking Joel's categories:
Otitis externa with soft tissue infection: The Oz guidelines only
cover otitis externa (no mention of associated soft tissue infection)
and don't recommend any systemic antibiotic for this condition
Severe presentations of acute exacerbation of chronic bronchitis: The
Oz guidelines recommend amoxycillin or doxycycline for 'exacerbations
of chronic bronchitis'. There is no mention of severity - presummably
this depends on the underlying lung disease.
Acute infective exacerbations of bronchiectasis: The Oz guidelines
don't specifically cover this.
Community acquired pneumonia in adults where there is co-morbidity
present:
The Oz guidelines recommend co-amoxy-clav for mild/moderate severity
pneumonia with co-morbidity, but only if a beta-lactamase producing
organism is suspected or 'response is slow'. It is not recommended
for severe pneumonia or for mild/moderate pneumonia with no
co-morbidity.
Mild/moderate/severe pneumonia in a nursing home setting: No specific
recommendation
Dog, cat and human bites: for animal or human bites the Oz guidelines
recommend procaine penicillin followed by co-amoxy-clav.
The overall intention in Australia still seems to be to restrict this
drug.
Hope this is helpful
Copies of the Australian Guidelines are available from the Victorian
Medical Postgraduate Foundation Inc. Chelsea House, 3rd Floor, 55
Flemington Road, North Melbourne, Viv 3051, AUSTRALIA Tel +61 3 9329
1566, Fax +61 3 9326 5632
David Henry
Discipline of Clinical Pharmacology,
Faculty of Medicine and Health Sciences,
The University of Newcastle,
Newcastle Mater Hospital,
Waratah, NSW, AUSTRALIA
Phone +61 (0)49 211856
Fax +61 (0)49 602088
Home +61 (0)49 505576
mddah@mail.newcastle.edu.au
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