amoxicillin-potassium-clavulanate-combination and Skin-Diseases--Infectious

The arrival of new cephalosporins faces the clinician with an evergrowing confusion as to the drug of choice. The older agents (cephalexin, cephradine, cefadroxil and cefaclor) and the newer formulations cefatrizine and cefuroxime axetil are intensively used for treatment of mild and moderate infections. The oldest agents have a better pharmacokinetic profile but are less active against Gram-positives and Gram-negatives. Cefaclor, cefatrizine and cefuroxime axetil have improved in vitro activity against H. influenzae and/or against S. aureus and M. catarrhalis. However the mean free serum concentrations after proposed standard daily doses of cefaclor (3 x 250 mg/d), cefatrizine (2 x 500 mg/d) and cefuroxime-axetil (2 x 250 mg/d) are lower than those of the older cephalosporins. In comparison amoxicillin-clavulanate is equally efficacious, has a more reliable pharmacokinetic profile and is less expensive than cefaclor and cefuroxime axetil in a comparable dose (e.g. 3 x 500 mg/d).

Topics: Administration, Oral; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Infections; Cephalosporins; Clavulanic Acids; Drug Therapy, Combination; Humans; Respiratory Tract Infections; Skin Diseases, Infectious; Structure-Activity Relationship

Amoxicillin/clavulanic acid, cefuroxime axetil, ciprofloxacin, and ofloxacin are each effective against many bacteria that cause infections in the skin and skin structures. Amoxicillin/clavulanic acid is potent against staphylococci, streptococci (including enterococci), and anaerobes, although adverse gastrointestinal reactions are common. Cefuroxime axetil is similarly effective yet is used only rarely because of its more common use in infections of the respiratory tract and the prevalent use of second-generation cephalosporins in surgical prophylaxis. The newer quinolones ciprofloxacin and ofloxacin are effective against staphylococci, Enterobacteriaceae, and Pseudomonas aeruginosa and exhibit only low toxicity; these agents have been used in many difficult tissue infections--notably, chronic infected ulcers in diabetic patients. Oral antimicrobial therapy, when chosen on the basis of culture and susceptibility results and combined with surgical debridement and local management, may be effective for many problematic infections of the skin and skin structures heretofore treated with parenteral antibiotics.

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Cefuroxime; Ciprofloxacin; Clavulanic Acids; Drug Therapy, Combination; Humans; Ofloxacin; Prodrugs; Skin Diseases, Infectious

Complicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality.. In this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196).. In the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group.. Tigecycline was generally safe and effective in the treatment of cSSSIs.. ClinicalTrials.gov NCT00368537.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Minocycline; Skin Diseases, Bacterial; Skin Diseases, Infectious; Sulbactam; Tigecycline

The efficacy of clavulanate-potentiated amoxycillin was compared with amoxycillin alone in experimental staphylococcal infection in dogs and in a controlled trial in clinical cases of skin infection in dogs and cats. The experimental infection was produced by subdermal inoculation with beta-lactamase producing (amoxycillin resistant) staphylococci absorbed in cotton dust. This produced discrete, localised lesions with no systemic involvement. In a cross over study, six animals were randomly allocated to treatment with either amoxycillin alone (10 mg/kg, dosed twice daily) or a formulation of clavulanate-potentiated amoxycillin (12.5 mg/kg, of a 1:4 ratio, dosed twice daily). The lesions of the animals treated with clavulanate-potentiated amoxycillin resolved more quickly than those treated with amoxycillin alone. The difference was significant (P less than 0.05) for both lesion diameter and inflammation score after day 6 of treatment. A trial was carried out in clinical cases of skin disease which were randomly allocated to twice daily treatment with either amoxycillin alone (10 or 20 mg/kg), or with clavulanate-potentiated amoxycillin (12.5 or 25 mg/kg of a 1:4 ratio). The required duration of treatment was shorter (P less than 0.5) for the potentiated amoxycillin treatments, and the success rate (judged by cure or substantial improvement) was higher (P less than 0.05) for this group, especially (P less than 0.01) where amoxycillin resistant organisms were isolated. It was concluded that clavulanate-potentiated amoxycillin was an effective treatment of skin infections both under experimental and clinical conditions.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Cat Diseases; Cats; Clavulanic Acids; Clinical Trials as Topic; Dog Diseases; Dogs; Drug Combinations; Random Allocation; Skin Diseases, Infectious; Staphylococcal Infections

BRL 25000 is a combination of a newly-developed beta-lactamase inhibitor clavulanic acid (CVA) and amoxicillin (AMPC) in the ratio of 1 to 2. The drug, as medium granules, was administered to a total of 92 pediatric patients, ranging in age from 1 month to 13 years and 2 months, with cutaneous/soft tissue infections (70 impetigo, 6 furuncle, 7 phlegmon, 6 abscess and 3 cases of lymphadenitis). It was found subsequently that 2 of the 70 impetigo cases had received topical antibiotic medication and these were excluded from clinical evaluation to give a total of 90 evaluable cases. The daily dosage of BRL 25000 ranged from 23.7 to 75.0 mg/kg, given in 3 or 4 divided doses (average 48.5 mg/kg) and the duration of treatment was for 3 to 13 days (average 6 days). Clinical isolates of S. aureus from the above cases were examined for beta-lactamase production and their susceptibility determined to the 5 antibiotics BRL 25000, AMPC, CVA, cephalexin (CEX) and cefaclor (CCL). The drugs' clinical effects on the various diseases, bacteriological effects and side effects were also studied. At an inoculum of 10(8) cells/ml, major MICs of BRL 25000, AMPC, CVA, CEX and CCL against 71 strains of S. aureus, including beta-lactamase negative ones, were 3.13 mcg/ml, 12.5 mcg/ml, 50 mcg/ml, 12.5 mcg/ml and 12.5 mcg/ml, accounting for 60.6, 38.0, 49.3, 38.0 and 43.7% of the strains respectively, whilst at an inoculum of 10(6) cells/ml, major MICs were 1.56 mcg/ml, 3.13 mcg/ml, 25 mcg/ml, 6.25 mcg/ml and 3.13 mcg/ml, accounting for 57.7, 33.8, 83.1, 50.7 and 54.9%, respectively. It was noted that all drugs tended to show smaller MIC values as the inoculum size was reduced to 10(6) cells/ml and that BRL 25000 showed the most potent antibacterial activity of all 5 drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Child; Child, Preschool; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Female; Humans; Infant; Male; Penicillin Resistance; Skin Diseases, Infectious; Staphylococcus aureus

Sixty-four patients were entered into a double-blind study of Augmentin and cefaclor. Pathogenic bacteria were recovered from twenty-one patients who received Augmentin and seventeen patients who received cefaclor. The primary diagnoses were pyodermas and impetigo, as well as cellulitis, folliculitis, infected skin structure, and infected surgical sites. Eighty-one percent of the Augmentin-treated patients were classified as successfully treated, based on clinical and bacteriologic criteria, as were eighty-nine percent of the patients treated with cefaclor. Side effects were minimal in both groups; no laboratory abnormalities were found. Both Augmentin and cefaclor are useful oral antimicrobial agents in the treatment of infections of the skin and skin structure.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cefaclor; Cephalexin; Clavulanic Acids; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Penicillin Resistance; Skin Diseases, Infectious

Topics: Abscess; Actinomycetales Infections; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Female; Gordonia Bacterium; Humans; Injections, Subcutaneous; Middle Aged; Skin Diseases, Infectious

A 58-year-old man presented to the hospital with fever and headache after amoxicillin intake. Physical examination, laboratory, and a cranial CT scan were unremarkable. Cerebrospinal fluid (CSF) testing revealed lymphocytic pleocytosis. After discontinuation of amoxicillin and symptomatic care, the patient quickly improved. Interestingly, he had had two prior episodes of aseptic meningitis that were probably also related to the administration of amoxicillin. Aseptic meningitis can be caused by multiple non-infectious conditions including drugs, malignancy, and autoimmune diseases. We report a case associated with amoxicillin that meets the criteria of drug-induced aseptic meningitis. Considering the wide utilization of amoxicillin, healthcare providers should be aware of it as a possible cause of drug-induced aseptic meningitis.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Humans; Male; Meningitis, Aseptic; Middle Aged; Skin Diseases, Infectious

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Clavulanic Acids; Connective Tissue Diseases; Drug Combinations; Humans; Skin Diseases, Infectious; Urinary Tract Infections

Thirty-two patients with skin infections were treated with Augmentin, a combination of amoxycillin with the beta-lactamase inhibitor clavulanic acid. These infections were primary skin sepsis (7), infected eczema (11), infected trauma (10) and leg ulcers (4). The majority of cases were caused by amoxycillin-resistant Staphylococcus aureus either alone or in combination with Streptococcus pyogenes. Thirty patients (94%) responded to treatment with only one withdrawal (for side effects). Side effects were limited to nausea (9%) diarrhoea (9%) and rash (3%). No patient with diarrhoea showed evidence of Clostridium difficile toxin production in the stools. Augmentin appears to be a safe, useful, effective antibiotic for the treatment of skin infections in general practice and in hospital. It may prove of particular value when mixed infections of penicillin-resistant staphylococci and Streptococcus pyogenes are present.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Drug Combinations; Humans; Microbial Sensitivity Tests; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus