Orally administered amoxicillin/clavulanate: current role in outpatient therapy
Open accessAbstract
Oral amoxicillin/clavulanate is a community workhorse antibiotic, routinely prescribed for respiratory tract infections, skin infections as well as urinary tract infections (UTIs). Multiple adult and paediatric dose formulations of amoxicillin/clavulanate are available in different parts of the world. In adult formulations, clavulanic acid dose is restricted to 125 mg because of tolerability issues. Despite its popular use for 40 years, few pharmacokinetic/pharmacodynamic (PK/PD) studies were undertaken to justify the doses and breakpoints currently in use for various infections. Clavulanate has a minimal role in the combination's use for respiratory infections. In the context of rising extended spectrum beta-lactamase (ESBL) prevalence globally, empirical and overuse of orally administered amoxicillin/clavulanate may select resistance in Gram-negative pathogens. The susceptibility test methods and interpretive criteria differ between the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Third-generation oral cephalosporins such as ceftibuten or cefpodoxime can be combined with amoxicillin/clavulanate to tackle UTIs involving ESBL producing Escherichia coli and Klebsiella spp. Clinicians who routinely prescribe amoxicillin/clavulanate in outpatient settings should be aware of potential benefits and limitations of this combination.
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Irrational and indiscriminate use of amoxicillin and clavulanic acid has become a global concern and has contributed to antimicrobial resistance.
“The irrational and indiscriminate use of amoxicillin and clavulanic acid has become a global concern. Excessive duration, suboptimal dosing, and inappropriate indication selection have all contributed to the growing challenge of antimicrobial resistance to amoxicillin and clavulanic acid [4,5].”
From Clinical Outcomes and Real-World Effectiveness of Amoxicillin-Clavulanic Acid Across Indian Healthcare Settings: A Retrospective Multicenter Study (2026) · cites this paper as [5]
The Abstract (page unavailable) says that empirical use and overuse of oral amoxicillin/clavulanate may select resistance in Gram-negative pathogens, supporting the general concern. It does not identify excessive duration, suboptimal dosing, or inappropriate indication selection as contributors, and the citing sentence states the contribution more definitively than the source does. (LLM, conf=0.86)
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References 34 · Cited by 44
- Authors
- Veeraraghavan, B., Bakthavatchalam, Y. D., & Sahni, R. D.
- Affiliations
- Christian Medical College, Vellore (IN)
- Corresponding author
- Veeraraghavan, Balaji
- Venue
- Infectious Diseases and Therapy
- Published
- 2020-12-11
- Volume
- 10
- Issue
- 1
- Pages
- 15-25
- ISSN
- 2193-6382 (ISSN-L)
- 2193-8229
- PMC
- PMC7954971
- OpenAlex
- W3111269510
- Cited by
- 44
- References
- 34
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 14 · 2023: 5 · 2022: 8 · 2021: 3
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Infectious Diseases and Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- amoxicillin-clavulanic acid, clavulanic acid, outpatient antibiotic therapy, extended-spectrum beta-lactamase, antimicrobial resistance, urinary tract infection, respiratory infections, skin infections, pharmacokinetics/pharmacodynamics, Escherichia coli, Klebsiella
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