amoxicillin-potassium-clavulanate-combination and Nausea

Acute pancreatitis is an acute inflammation of the pancreas that varies in severity from mild to life threatening usually requiring hospitalization. The true incidence of drug-induced pancreatitis (DIP) is indeterminate due to the inadequate documentation of case reports of DIP. Here we present the case of amoxicillin/clavulanic acid-induced pancreatitis in a previously healthy male after excluding all other causes of pancreatitis.. A 58-year-old Caucasian man presenting for acute sharp abdominal pain with associated nausea and heaves. Pain was non-radiating and worsening with movement. Patient had no constitutional symptoms. The only medication he received prior to presentation was amoxicillin/clavulanic acid as prophylaxis for a dental procedure with his symptoms starting on day 9th of therapy. Laboratory studies revealed mild leukocytosis, increased levels of serum lipase, amylase, and C-reactive protein (CRP). Abdominal computed tomography (CT) was notable for acute pancreatitis with no pseudocyst formation. Hence, patient was diagnosed with mild acute pancreatitis that was treated with aggressive intravenous (IV) hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h. On further questioning, patient recalled that several years ago he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. All other causes of pancreatitis were ruled out in this patient who is non-alcoholic, non-smoker, and never had gallstones. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) eliminated out the possibility of gallstones, biliary ductal dilatation, or choledocholithiasis. Patient had no hypertriglyceridemia nor hypercalcemia, never had endoscopic retrograde cholangiopancreatography (ERCP), never took steroids, has no known malignancy, infection, trauma, or exposure to scorpions.. This case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded. Only two other case reports were available through literature review regarding amoxicillin/clavulanic acid- induced pancreatitis. We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.

Topics: Abdominal Pain; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Cholangiopancreatography, Magnetic Resonance; Humans; Male; Middle Aged; Nausea; Pancreatitis; Tomography, X-Ray Computed; Ultrasonography; Vomiting

The treatment of bacterial pneumonia requires an agent with activity against a wide range of bacterial pathogens, including pathogens that produce beta-lactamase. Loracarbef, a member of the carbacephem class of antibiotics, was tested in a series of clinical trials for its efficacy and safety in the treatment of lobar and bronchial bacterial pneumonia. Successful clinical responses were achieved in 97.6% of the evaluable patients receiving 400 mg twice daily of loracarbef. This compared favorably with the respective response rates of 92.3% for patients receiving 500 mg three times a day of amoxicillin/clavulanate and 95.0% for patients receiving 500 mg three times a day of amoxicillin for the same illnesses. Proven or presumed elimination of the pretherapy pathogen was found in 89% of the patients receiving loracarbef, 92.3% of the amoxicillin/clavulanate-treated patients, and 70.0% of those receiving amoxicillin. Loracarbef was also well tolerated, although nausea and vomiting were associated with the use of all three agents. Nevertheless, treatment with loracarbef resulted in the lowest rate of discontinuation of therapy due to drug-related adverse events. Thus, these clinical trials support the conclusion that loracarbef is a safe and effective treatment for bacterial pneumonia.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Infections; Cephalosporins; Clavulanic Acids; Drug Therapy, Combination; Humans; Nausea; Pneumonia; Randomized Controlled Trials as Topic; Vomiting

This is the first prospective clinical trial in which patients with acute bacterial exacerbation of chronic bronchitis have been stratified by degree of underlying illness. Uncomplicated patients were randomised to levofloxacin 750 mg once daily (q.d.) for 3 days or azithromycin q.d. for 5 days. Complicated patients were randomised to levofloxacin 750 mg q.d. for 5 days or amoxicillin 875 mg/clavulanate 125 mg twice daily for 10 days. Regardless of therapy, complicated patients demonstrated lower clinical and microbiological success than uncomplicated patients. Clinical success for clinically evaluable patients was similar for levofloxacin and azithromycin (93.0 versus 90.1%, respectively), and levofloxacin and amoxicillin/clavulanate (79.2 versus 81.7%, respectively). For microbiologically evaluable patients, clinical response to levofloxacin for 3 days was superior to azithromycin for 5 days (96.3 versus 87.4%, respectively), and levofloxacin for 5 days was similar to amoxicillin/clavulanate for 10 days (81.4 versus 80.9%, respectively). Microbiological eradication was superior for levofloxacin for 3 days compared with azithromycin for 5 days (93.8 versus 82.8%, respectively), and similar for levofloxacin and amoxicillin/clavulanate for 10 days (81.4 versus 79.8%, respectively). In conclusion, levofloxacin 750 mg for 3 days was comparable to azithromycin for 5 days for uncomplicated patients with acute bacterial exacerbation of chronic bronchitis, while 5 days of 750 mg levofloxacin was comparable to 10 days of amoxicillin/clavulanate for complicated acute bacterial exacerbation of chronic bronchitis.

Topics: Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis, Chronic; Chronic Disease; Cost-Benefit Analysis; Diarrhea; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Haemophilus influenzae; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Nausea; Ofloxacin; Patient Selection; Streptococcus pneumoniae; Treatment Outcome

Augmentin and oxytetracycline were compared in the treatment of chest infections in general practice in an investigator-blind study of 748 patients randomly allocated to 7 days' treatment with standard doses of either Augmentin or oxytetracycline. Significantly more patients treated with Augmentin had a good overall response to therapy both at day 7 (P less than 0.001) and at day 14 (P less than 0.01). The differences between treatments were less marked for individual signs and symptoms of lower respiratory tract infections, due to smaller numbers of patients with any particular symptom. Augmentin, however, was significantly more effective than oxytetracycline in the resolution of chest pain at day 7 (P less than 0.025) and cough at day 14 (P less than 0.005). Sputum purulence was also cleared more effectively by Augmentin by day 14 (P less than 0.001). Both treatments were well tolerated, with no significant difference between treatments in the small number of adverse events. Augmentin has been shown to be an effective, well tolerated treatment for chest infections, superior to oxytetracycline in efficacy and possibly in speed of resolution of clinical symptoms.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Clinical Trials as Topic; Diarrhea; Drug Combinations; Humans; Middle Aged; Nausea; Oxytetracycline; Random Allocation; Respiratory Tract Infections; Sputum