Antibiotic dose: Augmentin, 1g?

Life Health & Fitness
1

Hi,

Had surgery. Wasn’t prescribed preventative antibiotics. Week later, doc reconsidered and gave me a prescription (Augmentin, which is amoxicillin). Of course, it is for 3 days only. Troublesome and often dangerous habit here. Additionally, the pill size is 1g. Yeah, 1,000 mg! It’s a horse pill.

Here’s the thing: While normally antibiotics are prescribed for a longer course of 7, 10, or 14 days, the trend in recent years has been toward stronger meds, per pill, and shorter courses (# of days). I’m wondering, if in this case, maybe this isn’t Taiwanese business as usual with meds, but 3 days of 1g x 2 is actually right.

I managed to get more of this stuff from a pharmacy, but now I don’t know how long to take it.

What I need is a reference source (online or person you know) to check on the dosage range and normal course for this drug, when used as a general preventative against wound infection or to kill a minor one.

And whether reducing the dosage midstream to say, 750mg, would cause any problems.

Ideal: An online source that says “med name, normal dosage, normal course”, etc. Or, your sister back home is a doc :slight_smile:

Thanks for any help or opinions.

Seeker4

2

Sorry, been having that “too much detail” affect on people lately. Let me try again:

“So, like the doctor, man, gave me some drugs. Yeah, cool, right?! But, like, maybe not enough, dude. Never enough drugs. Only three days. But, like anyway, it’s some big ass pill. Think he said it kills infections …anti- … anti- … anti-psychotics. Yeah, that’s it. So, like, what should I do?”

3

For surgery the most common organism you want to protect against is staphylococcus. The antibiotics most used for this purpose by the otolaryngologist that I work with are Keflex or Duricef after surgery (these are 1st generation cephalosporins/the class of antibiotic). Oftentimes, a patient will get some IV antibiotics as the surgery is beginning, sometimes just prior to.

In our office, we often use Augmentin which is Amoxicillin augmented by Clavulanate for sinus infections. The dosage for sinus infections is 875mg(of the Amoxicillin part, I forget the corresponding dose of the Cl. acid) every twelve hours for 10 days. I am no surgeon, but I think the choice of antibiotic and the dosage is odd. Wrong antibiotic, and if it were the right one it is the wrong dosage.

It depends, really, on what part of the body you were operated upon as well. Different bugs like to live different places.

[quote][url=http://www.ampath.co.za/AntiBiotGuide/chapter6.htm]Fundamental principles of Surgical Prophylaxis
o The antibiotic must be in the tissue before the bacteria are introduced i.e. antibiotic must be given intravenously shortly before surgery to ensure high blood / tissue levels. Prophylaxis failure may be due to antibiotics given too late or more often, given too early. The half-life of the particular antibiotic is therefore important.

o There is no data to support more than a single dose. Further doses generally constitute treatment. Note the waste of resources, the in-creased risk of complications and the fact that multiple doses are not associated with increased efficiency.

o The chosen antibiotics must be active against the most common ex-pected pathogens.

o Deviations from these guidelines may be warranted in certain situations, e.g. MRSA outbreak in an individual hospital.

o High risk patients, e.g. patients with jaundice or diabetics, or patients who undergo any procedures to insert prosthetic devices, generally warrant antibiotic prophylaxis.

N.B. There are no convincing statistical differences in efficacy between the 1st, 2nd or 3rd generation cephalosporins, therefore a 1st generation cephalosporin MUST be the preferred option[/url].[/quote]
Don’t know if this URL/reference is too “technical” for the layperson, but if you’re interested there’s a chart at the bottom that indicates the appropriate antibiotic for the organism, and which surgeries encounter which organisms, and it gives dosages and routes of medication administration, i.e., IV or pill or intrmuscular injection.

So, duuude, what kind of surgery did you have, duuude? :wink:

Bodo

Bodo

4

Inguinal hernia.

Not at all. That article was right on target and helped. It complimented what I had already found.

I ended up doing a bit more research on this myself. Learned some interesting things. Two different terms and methods used for two situations – 1) antibiotics given prior to/during surgery and 2) that given after. The first is called prophylactic treatment. The second is empiric therapy. The goal of both is the same; prevention of infection, but methods and drugs chosen normally are different.

While I was given prophylactic antibiotics by IV within a two-hour timeframe before surgery, I was not given empiric antibiotic therapy immediately following surgery. At a follow-up appointment one week later, I was given the amoxicillin that was the topic of this thread because the doctor “saw some redness.” When I asked why I didn’t receive empiric antibiotics immediately after surgery, he said that is not routinely done unless the patient is over 65 years of age. My research didn’t bear that out as standard practice. Must be either the surgeon’s own idea or dictated by NHI.

I sought other medical opinions in Taiwan for this thread question. In short, didn’t get consensus. Got statements without explanation. Hard to conclude. For a few reasons, I decided to go with the 3-day course prescribed by the surgeon and stop after that.

I also learned that, while Taiwan may have its own peculiar problem with the “everything for 3 days only” practice, inappropriate use of antibiotics, both prophylactic and empiric, exist everywhere. It is a major issue that hospitals and medical educators are struggling with because it has a significant impact on patient health and overall cost.

All said, I’m still missing one basic piece of knowledge that I’d like to know. That is, in general, how do doctors decide the length of the antibiotic course?

On one hand, over the years I’d picked up a sense that there was some magic relationship between a particular medicine and a particular number of days. For example, blahblahocillin must always be taken for 10 days while whateverocillin only 7 days. And that those time limits must be strictly adhered to. On the other hand, I’m beginning to believe now that any of them could be taken for any length of time, with the deciding factor being what I’ll call the optimal window. That is the timeframe that is long enough to kill the bacteria, and long and short enough to prevent antibiotic resistance or superinfection conditions (too short is a problem, too long is a problem). There are likely guidelines published for physicians (PDR?, drug company literature?), but I believe that the optimal window depends on the situation and so it comes down to a judgment call on the part of the doctor. Maybe in a case like mine, where infection is not certain, 3 days of the right antibiotic in the right dosage is enough.

Bodo, thanks for taking a swing at the question.

5

Ya, the pharmacologist and PhD MDs have figured out over the years, how drugs penetrate to the target area, how to kill the bacteria (some antibiotics are time-dependent killers, the longer the bacteria are exposed the more you kill, and some are concentration dependent meaning you have to get enough drug to the target area and then you’ll get good bacteriocidal results). Anywho . . . a frequently used reference for antibiotics in the U.S. (everyone resident has one) is “The Sanford Guide to Antimicrobial Therapy.”

Bodo

6

This information may be a bit late. Anyhow, the augmentin 1000mg is an extended release and is given every 12 hours. It is a newer preparation than the other doses. As to the duration of a course of antibiotics, there are some standard recommended durations for certain infections (sinusitis, pericarditis, uncomplicated urinary tract infections), but many other infections or empiric treatments are fairly arbitrary. A few years back, a study surveying the duration of
antibiotic use in several US hospitals (teaching/research hospitals I think) found that the duration of antibiotics correlated best with hospital discharge. So basicaly, people were left on antibiotics so long as they are still in the hospital, never mind that they may be spending the last several days in the hospital waiting for nursing home placement. to my knowlege, no similar study was done for the outpatient setting.

7

[quote=“arabe”]This information may be a bit late. Anyhow, the augmentin 1000mg is an extended release and is given every 12 hours. It is a newer preparation than the other doses. As to the duration of a course of antibiotics, there are some standard recommended durations for certain infections (sinusitis, pericarditis, uncomplicated urinary tract infections), but many other infections or empiric treatments are fairly arbitrary. A few years back, a study surveying the duration of
antibiotic use in several US hospitals (teaching/research hospitals I think) found that the duration of antibiotics correlated best with hospital discharge. So basicaly, people were left on antibiotics so long as they are still in the hospital, never mind that they may be spending the last several days in the hospital waiting for nursing home placement. to my knowlege, no similar study was done for the outpatient setting.[/quote]
Info is always good to have, if not for one case, then for next time. Thanks.

So the question that remains for me, Arabe, is whether a 3-day course of 1000mg augmentin would be safe/prudent in any circumstances and for any illness OR is that still too short to be effective and so likely contributes to bacteria resistance?

8

3 days of antibiotics, other than being used for simple urinary tract infections (female with no anatomic abnormality in the urinary tract) or used in prophylactic setting (which is generally anywhere from one dose to three doses depending on the type of procedure and 1st dose given about 1 hr before procedure) is a bit short . More commonly, a 7 to 10 day course is prescribed. There is a lack of study on optimal duration of treatment in general, so the 7-10days are more conventional than evidence based. If the infection is not definite, and the doctor is waffling between antibiotics vs. none, I see how a 3 day course may be prescribed. But it is not conventional by western medicine standard-do you or don’t you want to treat?.

Bear in mind that we used to give a longer course of antibiotic for the above mentional bladder infection until a study came about showing that the group of women given a 3 day course of antibiotic did as well as the group of women given a longer course of antibiotic for bladder infections.

9

A large dose of augmentin every 12 house like what you’ve got seems a bit odd since it sounds like the infection is in a place that’s not so easily penetrated. On the label, is there anything other than amoxicillin and clavulanate potassium? Has the doctor also given you a drug called probenecid to take with the augmentin? For sytemic or deep tissue infections, augmentin alone, even if taken in large doses, will not produce the serum levels required to penetrate the tissues where the infection lies with the ideal amount of strength. I think that’s why doctors seem to use other antibiotics for empiric treatment. In places where a variety of antibiotics are not available, i.e. an aid mission in Africa, they will first treat a lot more infections with plain old amoxicillin since it’s cheap and easier to store. For empiric therapy or for deep tissue infections, they would definitely give probenecid to slow the excretion of the amoxicillin, thus causing much higher peak serum levels and longer working time for the drug. Even with probenecid, three days sounds short.

10

I don’t know of anyone still using probenecid for the purpose you described. It’s something you read in pharmacology text book but in practice, just about no one uses it that way any more. Probenecid is still used for gout now and then. Augmentin is fine foruse in that setting. If it is a serious infection, seeker 4 would need to be hospitalized for IV antibiotics +/- wound debridement.

11

My doctor told me that she was only allowed to prescribe meds for three days by the NHI thenn you need to return to get a new perscription. When my kids have needed medications I have had to go back 4 or 5 times to finish the course of anti-biotics.

12

I’m sorry, I’ll clarify. The only time I’ve heard of probenecid still being used with certain antibiotics is in very out of the way places with very poor resources. Interestingly, a year or so ago when everyone was worrying about an H5N1 pandemic and the low stocks of tamiflu (which of couse is going to save all of us), I saw a couple of articles about doctors experimenting with using probenecid and tamiflu together to make the latter last longer. I can’t remember the details, but the conclusion was that probenecid will work with tamiflu in much the same way it slows excretion of antibiotics.

Perhaps others who are more in the know will correct me, but this strikes me as a crock of BS. What costs the NHI more, a sack of antibiotics that cost 4 or 5 NT a pill, or the consultation fees that a physician collects every time he can stamp a patient’s card? I’m sure that there are lots of medicines for which there is no generic alternative and that do cost the NHI more than what they pay a doctor, but how many commonly prescribed antibiotics are that expensive?

In HK and Taiwan, whenever I’ve been to a private GP, I’ve only been given 3 days of antibiotics when they were prescribed. Except for one better doctor in Taichung, I don’t recall EVER being asked to return in 3 days for follow up and another bag of antibiotics. Contast this to the one time I went to a hospital in Taiwan with high fever and the times I’ve been to government clinics or hospitals in HK. At the government places, I was always given what seemed like a reasonable course of antibiotics, ranging from 6 to 12 days.

13

I go to both a local clinic and a hospital and the both have had me come back every three days to finish a course of antibiotics. (shrug)