Effects of hemodialysis on the pharmacokinetics of amoxicillin/clavulanic acid combination.
The effects that renal disease and hemodialysis have on the pharmacokinetics of amoxicillin/clavulanic acid combination were studied in a patient receiving this combination for the treatment of a Nocardia asteroides infection. Hemodialysis increased the clearance of both substances as evidenced by lower serum concentrations during the on-dialysis day, i.e., 2.3 +/- 0.8 vs. 5.9 +/- 1.2 micrograms/ml for clavulanic acid and 8.0 +/- 1.8 vs. 12.4 +/- 0.9 micrograms/ml for amoxicillin. Clavulanic acid appeared to be influenced to a greater extent as compared to amoxicillin because of its higher extraction ratio (0.74 vs. 0.44) as well as a higher observed ratio of amoxicillin to clavulanic acid during the on-dialysis day (3.59 +/- 1.27 vs. 2.28 +/- 0.65; p less than 0.05). Comparison of the area under the serum concentration-time (AUC) during the off-dialysis day with published AUC values suggested accumulation of amoxicillin/clavulanic acid. These data indicate that dosage adjustments for amoxicillin/clavulanic acid may be required in patients with chronic renal failure who are on hemodialysis. Further studies in this patient population are needed before specific dosing guidelines can be provided.
D000658:Amoxicillin / Q000378:metabolism*; D000900:Anti-Bacterial Agents / Q000378:metabolism*; D002648:Child; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000378:metabolism*; D004338:Drug Combinations; D005260:Female; D006207:Half-Life; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007700:Kinetics; D009617:Nocardia Infections / Q000188:drug therapy; D009616:Nocardia asteroides / Q000187:drug effects; D006435:Renal Dialysis
D000900:Anti-Bacterial Agents; D002969:Clavulanic Acids; D004338:Drug Combinations; D019818:Clavulanic Acid; D000658:Amoxicillin