E-DRUG: paediatric amoxiclav - different ratio needed for higher dosages?
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Dear E-druggers,
The current WHO model list for children lists 3 dosage forms for amoxiclav
(amoxicillin + clavulanic acid):
Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL AND 250 mg
amoxicillin + 62.5 mg clavulanic acid/5 mL.
Tablet: 500 mg (as trihydrate) + 125 mg (as potassiumsalt).
The standard ratio in all of these is 4:1.
If a higher dose of amoxicillin is needed, the risk exists that too much
clavulanic acid is given.
If a higher daily dose of amoxicillin is required, some textbooks recommend
that another preparation of Co-amoxiclav is selected in order to avoid
administration of unnecessarily high daily doses of clavulanic acid (so not
4:1 but higher, eg 8:1)
I have the following questions:
- Is this "overdosing" of clavulanic acid a common problem?
- Are there special dosage forms of amoxiclav with an 8:1 ratio? If
so, who makes this?
- Or do prescribers just add "plain" amoxicillin in the absence of
8:1 ratio amoxiclavs?
Please send comments and suggestions directly to wjb@wxs.nl
Thanks!
Wilbert
Wilbert Bannenberg, public health consultant
Founder and co-moderator of E-drug
Moderator email: owner-e-drug@healthnet.org
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E-DRUG: Paediatric amoxiclav - different ratio needed for higher dosages? (2)
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Dear Wilbert,
in Switzerland there are three pediatric dosages for amoxiclav:
- 400mg amoxicillin + 57mg clavulanic acid/5ml (7:1 - only as Augmentin Duo from GSK)
- 250mg amoxicillin + 62mg clavulanic acid/5ml (4:1)
- 125mg amoxicillin + 31.25mg clavulanic acid/5ml
The 7:1 preparation is registered for the twice daily dosing (for otitis and mild to moderately severe lower respiratory infections), the 4:1 dosages are registered for three times daily dosing.
Twice daily dosing is associated with less diarrhea (as less clavulanic acid).
For higher doses, to overcome S.pneumoniae resistance (80-90mg/kg/24h amoxicillin component), the "Johns Hopkins Hospital Harriet Lane Handbook" (extensively used by pediatricians) recommends to use the 7:1 twice daily dosing (which is what I use).
I would say that the 7:1 dosing is the most important for its twice daily dosing and the possibility to double the dose when needed.
Best,
Tido
Tido von Schoen-Angerer, MD, MPH
Pediatrician FMH, Anthroposophic medicine FMH/ VAOAS
Centre Medical de La Chapelle, Geneva, Switzerland
Dept of Pediatrics, Fribourg Hospital, Fribourg, Switzerland
Researcher, ARCIM Institut, Filderklinik, Filderstadt, Germany
Tido von Schoen-Angerer <tido.von.schoenangerer@gmail.com>
E-DRUG: Paediatric amoxiclav - different ratio needed for higher dosages? (3)
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[We encourage e-druggers to respond to the information presented in this message as invited by Dr Bukhari. BS]
I believe they role of clavulanic acid is Enzyme inhibition and best combination is by Innovator and most important is product stability that is best with innovator. Hardly any Generic is there to give same stability.
In Pakistan BD dose has ratio more than 1:7 by innovator, as after Optimum Quantity of Clavulanic acid it become irrelevant with efficacy .
It will interesting for e-druggers to compare different FPP [finished pharmaceutical product?BS] by different manufacturers for analysis.
This Product is one of most difficult product to maintain stability.
As thumb rule you cannot change your formulation better than Innovator other wise you need to conduct clinical studies.
Syed Khalid Saeed Bukhari
Country Advisor Medicine & Health Products
Doctor of Pharmacy, M.Phil,FRSC,MCPA.
Pakistan
Khalid Saeed BUKHARI <skhs77@gmail.com>