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Pulmonology Case No 4.Productive Cough  

Productive cough এ এন্টিহিস্টামিন দেওয়া নিষেধ…

সর্দি হলে আমরা সাধারণত এন্টি হিস্টামিন দিয়ে থাকি, তবে এখানে সবচেয়ে গুরুত্বপূর্ণ বিষয় হচ্ছে সর্দির পরে যদি productive cough শুরু হয়, তাহলে এন্টি হিস্টামিন চলমান থাকলে তা দ্রুত বন্ধ করতে হবে, কারণ তখন এন্টি হিস্টামিন চলমান থাকলে কাশী আরো ঘন হয়ে যাবে, এবং ফুসফুসে জমে যেতে পারে, কারণ এন্টি হিস্টামিন ভ্যাসো কন্সট্রিকশন হিসাবে কাজ করে।

এখন ধরুন, কারো rhinitis বা অনেক নাকের পানি পড়তেছে, সাথে আবার কাশিও আছে, productive cough.

তখন কি করবো?

তখন সর্দির জন্য এন্টিহিস্টামিন দেওয়া লাগলে আমরা কিভাবে ম্যানেজ করবো?

সর্দি + productive cough থাকলে আমরা সর্দির জন্য Nasal drop ব্যবহার করতে হবে… কোনো এন্টিহিস্টামিন দেওয়া যাবেনা… আর কাশির জন্য Mucolytic agent ব্যবহার করতে হবে.

Rx::

NasalDrop1.Afrin 0.025% 10ml Drop (AS A Oxymetazoline Hydrochloride Nasal Anti-histamine preparations, Nasal Decongestants & Other Nasal Preparations)

2 drop in each nostril BD for 7 days.

 Ambrox

Syrup 2: Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Indications of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox is indicated in-

  • Productive cough
  • Acute and chronic inflammatory disorders of upper and lower respiratory tracts associated with viscid mucus including acute and chronic bronchitis
  • Inflammatory disease of rhinopharyngeal tract (laryngitis, pharyngitis, sinusitis and rhinitis) associated with viscid mucus
  • Asthmatic bronchitis bronchial asthma with thick expectoration
  • Bronchiectasis
  • Chronic pneumonia etc.

Pharmacology of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambroxol is the active metabolite of bromhexine and it has been proven that this metabolite possesses a greater bronchosecretolytic effect than bromhexine. It improves sputum rheology by hydrating mechanism leading to liquefaction of mucus in the lumen of respiratory tract, thus facilitating expectoration of mucus and reducing dyspnea. It stimulates production of phospholipids of surfactant by alveolar cells, thus contributing to the lowering of superficial tension in the alveoli. It also reduces bronchial hyperactivity. Ambroxol has anti inflammatory properties owing to the inhibitory effect on the production of cellular cytokines and arachidonic acid metabolites. In patients with COPD it traditionally improves airway patency.

Dosage & Administration of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Average daily dose (preferably after meal):

Pediatric Drops:

  • 0-6 months: 0.5 ml 2 times a day
  • 6-12 months: 1 ml 2 times a day
  • 1-2 years: 1.25 ml 2 times a day

Syrup:

  • 2-5 years: 2.5 ml (1/2 teaspoonful) 2-3 times a day
  • 5-10 years: 5 ml (1 teaspoonful) 2-3 times a day
  • 10 years and adults: 10 ml (2 teaspoonful) 3 times a day.

Sustained release capsule: Adult and children over 12 years old: 1 capsule once daily.

Interaction of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox should not be taken simultaneously with antitussives (e.g.Codeine) because phlegm, which has been liquefied by Ambrox might not be expectorated.

Contraindications of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Contraindicated in known hypersensitivity to Ambroxol or Bromhexine.

Side Effects of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Gastrointestinal side effects like epigastric pain, stomach overfill feeling may occur occasionally. Rarely allergic responses such as eruption, urticaria or angioneurotic edema have been reported.

Pregnancy & Lactation of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Teratogenic and fetal toxicity studies have shown no harmful effect of Ambroxol. However, it is advised not to use it in pregnancy, especially during the1st trimester. Safety during lactation has not been established yet.

Precautions & Warnings of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox should be given cautiously to patients with gastric and duodenal ulceration or convulsive disorders. Patients with hepatic and renal insufficiency should take it with caution.

Therapeutic Class of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Cough expectorants & mucolytics

১/২ চামচ করে দিনে ২ বার-

২ থেকে ৫ বছর: ১ চামচ করে দিনে ২ বার—

2 TSF 8 hourly for 1-2 weeks.

OR Mucolyt:-

 Syrup 3: Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Indications of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Mucolyt is indicated in the treatment of respiratory tract disorders associated with productive cough. This include-

  • Tracheobronchitis
  • Bronchitis with emphysema
  • Bronchiectasis
  • Bronchitis with bronchospasm
  • Chronic inflammatory pulmonary conditions and
  • Pneumoconiosis.

Pharmacology of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Bromhexine Hydrochloride is an oral mucolytic agent. It disrupts the structure of acid mucopolysaccharide fibres in mucoid sputum and produces less viscous mucus, which makes easier the expectoration. It is rapidly & completely absorbed from the gastrointestinal tract. It is widely distributed into the body tissues.

Dosage & Administration of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

The recommended doses for adults and children are stated below:

  • Adult & Children over 12 years: 10 ml (2 teaspoons) 3 times daily
  • Children 6-12 years: 5 ml (1 teaspoon) 3 times daily
  • Children 2-6 years: 2.5 ml (1/2 teaspoon) 3 times daily
  • Bromhexine Hydrochloride is not recommended for children under 2 years of age without advice.

Interaction of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

There are no known significant interactions with other drugs.

Contraindications of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

It is contraindicated in known hypersensitivity to Bromhexine Hydrochloride or any of the ingredients of this product.

Side Effects of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Gastrointestinal side effects may occur occasionally. A transient rise in serum aminotransferase values has been reported. Other reported side effects include-headache, vertigo (dizziness) and allergic reactions.

Pregnancy & Lactation of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Use in Pregnancy: Special care is recommended during pregnancy. The benefits of bromhexine must be assessed against possible effects on children.

Use in Lactation: Bromhexine is expected to enter breast milk. Therefore it is not recommended that bromhexine be taken by lactating mothers.

Precautions & Warnings of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Since mucolytics may disrupt the gastric mucosa bromhexine should be used with care in patients with a history of peptic ulcer disease. Care is also advisable in asthmatic patients. Clearance of bromhexine and its metabolites may be reduced in patients with severe hepatic or renal impairment.

Therapeutic Class of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Cough expectorants & mucolytics

Antibiotics কি দিবেন? For Cough Infection:-

Cefuroxime /Moxaclav

Both UTI and RTI same time-

Tablet 1:- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Indications of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Cefotil Plus is indicated for the treatment of infections caused by sensitive bacteria.

  • Pharyngitis/Tonsillitis caused by Streptococcus pyogenes.
  • Acute Bacterial Otitis Media caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis (beta-lactamase producing strains) or Streptococcus pyogenes.
  • Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenzae (non beta-lactamase producing strains)
  • Lower respiratory tract infections including pneumoniae, caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta lactamase-producing strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pyogenes, E. coli.
  • Acute bacterial exacerbation of chronic bronchitis and secondary bacterial infections of Acute bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (beta-lactamase negative strains) or Haemophilus parainfluenzae (beta-lactamase negative strains).
  • Uncomplicated skin and skin-structure infections caused by Staphylococcus aureus (including beta-lactamase producing strains) or Streptococcus pyogenes.
  • Uncomplicated urinary tract infections caused by E.coli or Klebsiella pneumoniae.
  • Bone and Joint Infections caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains).
  • Uncomplicated Gonorrhoea caused by penicillinase-producing and non-penicillinase producing strains of Neisseria gonorrhoeae.
  • Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi.
  • Septicemia caused by Staphylococcus aureus, Streptococcus pneumoniae, E.coli, Haemophilus influenzae (including ampicillin-resistant strains) & Klebsiella spp.
  • Meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Neisseria meningitidis & Staphylococcus aureus (penicillinase and non-penicillinase producing strains)
  • Switch therapy (Injectable to oral)

Pharmacology of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Cefuroxime is a bactericidal second generation cephalosporin antibiotic which is active against a wide range of Gram-positive and Gram-negative susceptible organisms including many beta-lactamase producing strains. Cefuroxime inhibits bacterial cell wall synthesis by interfering with the transpeptidation process.

Clavulanic acid is a naturally derived beta lactamase inhibitor produced by Streptomyces clavuligerus. It has similar structure to beta lactam antibiotics which binds irreversibly to beta-lactamase enzymes and inactivates them. Clavulanic acid gives protection of Cefuroxime from degradation by beta lactamase enzymes and provides a solution for the treatment of bacterial infections caused by beta lactam resistant bacteria.

Dosage & Administration of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Adolescents and adults (13 years and older)-

  • Pharyngitis/tonsillitis: 250 mg b.i.d. for 5-10 days
  • Acute bacterial maxillary sinusitis: 250 mg b.i.d. for 10 days
  • Acute bacterial exacerbation of chronic bronchitis: 250-500 mg b.i.d. for 10 days
  • Secondary bacterial infections of acute bronchitis: 250-500 mg b.i.d. for 5-10 days 
  • Uncomplicated skin and skin structure infections: 250-500 mg b.i.d. for 10 days
  • Uncomplicated urinary tract infections: 250 mg b.i.d. for 7-10 days
  • Uncomplicated Gonorrhoea: 1000 mg b.i.d. Single dose
  • Community acquired pneumonia: 250-500 mg b.i.d. for 5-10 days
  • MDR Typhoid Fever: 500 mg b.i.d. for 10-14 days
  • Early Lyme disease: 500 mg b.i.d. for 20 days

Paediatric Patients (3 months to 12 years)-

  • Pharyngitis/Tonsillitis: 20 mg/kg/day b.i.d for 5-10 days
  • Acute otitis media: 30 mg/kg/day b.i.d for 10 days
  • Acute bacterial maxillary sinusitis: 30 mg/kg/day b.i.d for 10 days
  • Impetigo: 30 mg/kg/day b.i.d for 10 days

Cefuroxime-Clavulanic Acid tablet may be taken without regard of food.

Side Effects of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Generally Cefuroxime-Clavulanic Acid is well tolerated. However, a few side effects like nausea, vomiting, diarrhea, abdominal discomfort or pain may occur. As with other broad-spectrum antibiotics, prolonged administration of Cefuroxime and Clavulanic acid combination may result in overgrowth of nonsusceptible microorganisms. Rarely (<0.2%) renal dysfunction, anaphylaxis, angioedema, pruritis, rash and serum sickness like urticaria may appear.

Pregnancy & Lactation of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

While all antibiotics should be avoided in the first trimester if possible. However, Cefuroxime-Clavulanic Acid can be safely used in later pregnancy to treat urinary and other infections. Cefuroxime-Clavulanic Acid is excreted into the breast milk in small quantities. However, the possibility of sensitizing the infant should be kept in mind.

Therapeutic Class of Tablet :- Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)

Second generation Cephalosporins, Vaccines, Anti-sera & Immunoglobulin

OR Moxaclav(Broad Spectram Penicillines):-

Tablet 5:

Tablet 5:-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Indications of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Co-amoxiclav is indicated for short-term treatment of bacterial infections at the following sites:

  • Upper respiratory tract infections (including ENT) e.g.tonsillitis,sinusitis,otitis media.
  • Lower respiratory tract infections e.g.acute and chronic bronchitis, lobar and bronchopneumonia.
  • Genito-urinary tract infections e.g.cystitis,urethritis,pyelonephritis.
  • Skin and soft tissue infections.
  • Bone and joint infections e.g.osteomyelitis.
  • Other infections e.g.septic abortion,puerperal sepsis,intra-abdominal sepsis etc.

Composition

  • 375 mg tablet: Each film coated tablet contains Amoxicillin 250 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
  • 625 mg tablet: Each film coated tablet contains Amoxicillin 500 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
  • 1 gm tablet: Each film coated tablet contains Amoxicillin 875 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg Diluted Potassium Clavulanate BP.
  • Powder for Suspension: Each 5 ml reconstituted suspension contains Amoxicillin 125 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 31.25 mg as Diluted Potassium Clavulanate BP.
  • Powder for Suspension (Forte): Each 5 ml reconstituted suspension contains Amoxicillin 400 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 57.5 mg as Diluted Potassium Clavulanate BP.
  • 1.2 gm Injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 1 gm) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 200 mg).
  • 0.6 gm injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 500) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 100 mg).

Pharmacology of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Pharmacodynamic properties: Co-amoxiclav is an antibacterial combination consisting of the antibiotic Amoxicillin and the (3-lactamase inhibitor Clavulanic Acid. Amoxicillin has a broad spectrum of bactericidal activity against many Gram-positive & Gram-negative microorganisms but it is susceptible to degradation by (3-lactamases and therefore the spectrum of activity does not include microorganisms, which produce these enzymes. Clavulanic acid possesses the ability to inactivate a wide range of beta-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. Thus Clavulanic acid in this preparation protects Amoxicillin from degradation by (3-lactamase enzymes and effectively extends the antibiotic spectrum to embrace a wide range of microorganisms.

Pharmacokinetic properties: The pharmacokinetics of the two components of Co-amoxiclav is closely matched. Peak serum levels of both occur about one hour after oral administration. Absorption of Co-amoxiclav is optimized at the start of a meal. Both clavulanate and Amoxicillin have low levels of serum binding; about 70% remains free in the serum. Doubling the dosage of Co-amoxiclav approximately doubles the serum levels achieved.

Dosage of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Adults and children over 12 years:

Tablet:

  • The usual adult dose is one 625 mg Tablet every 12 hours or one 375 mg Tablet every 8 hours.
  • For more severe infections and infections of the respiratory tract, the dose should be one 1 gm Tablet every 12 hours or one 625 mg Tablet every 8 hours.

Suspension:

  • Children 6-12 years: 2 teaspoonful every 8 hours.
  • Children 1-6years: 1 teaspoonful every 8 hours.
  • Children below 1 year: 25 mg/kg/day in divided doses every 8 hours, for example a 7.5 kg child would require 2 ml suspension t.i.d, Treatment should not be extended beyond 14 days without review.

Forte suspension:

  • The usual recommended daily dosage: 25/3.6 mg/kg/day in mild to moderate infections (upper respiratory tract infections e.g. recurrent tonsilitis, lower respiratory infections, and skin and soft tissue infections)।
  • For serious infections: 45/6.4 mg/kg/day for the treatment of more serious infections (upper respiratory tract infections, e.g. otitis media and sinusitis, lower respiratory infections e.g. bronchopneumonia, and urinary tract infections).

Children of 2 to 12 years:
Mild to moderate infections:

  • 25/3.6 mg/kg/day (Suspension)
  • 2-6 years (13-21 kg) 2.5 ml suspension b.i.d
  • 7-12years (22-40kg) 5 ml suspension b.i.d

Serious infections:

  • 45/6.4 mg/kg/day (Forte Suspension)
  • 2-6 years (13-21 kg) 5 ml suspension b.i.d
  • 7-12 years (22-40 kg) 10 ml suspension b.i.d

IV Injection

Adults-

  • Usually, 1.2 gm every 8 hours
  • Increased in more serious infections to 1.2 gm every 6 hours
  • For surgical prophylaxis: The usual dose is 1.2 gm at induction, for high risk procedures (eg. colorectal surgery) up to 2-3 gm may be given every 8 hours.

Children-

  • 0 to 3 months: 30 mg/kg every 8 hours. (every 12 hours in the perinatal period and in premature infants.
  • 3 months to 12 years: Usually 30 mg/kg every 8 hours increased in more serious infection to 30 mg/kg every 6 hours.

Administration of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Oral dosage form: This may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when Amoxicillin and Clavulanic acid are administered at the start of a meal. To minimize the potential for gastrointestinal intolerance, Amoxicillin and Clavulanic acid should be taken at the start of the meal.

IV injection is not suitable for intramuscular or subcutaneous administration. The reconstituted vial can be administered intravenously by injection (over 2 minutes) or slow intravenous infusion (30 minutes). The contents of the content of the vial must be used within 20 minutes and thereafter any unused material should be discarded.

Interaction of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Prolongation of bleeding time and prothrombin time have been reported in some patients receiving Co-amoxiclav. In common with other broad-spectrum antibiotics, Co-amoxiclav may reduce the efficacy of oral contraceptives and patients should be warned accordingly. Concomitant use of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions. There are no data on the concomitant use of Co-amoxiclav and allopurinol.

Contraindications of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

History of Penicillin hypersensitivity. Attention should be paid to possible cross-sensitivity with other beta-lactam antibiotics e.g. cephalosporins. Also contraindicated for patients with a previous history of Co-amoxiclav or Penicillin-associated cholestatic jaundice.

Side Effects of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Side effects, as with Amoxicillin, are uncommon and mainly of a mild and transitory nature. Diarrhoea, pseudomembranous colitis, indigestion, nausea, vomiting and candidiasis have been reported, if gastrointestinal side effects occur with oral therapy, that may be reduced by taking Co-amoxiclav at the start of meals. Hepatitis and cholestatic jaundice have been reported rarely but are usually reversible. Urticarial and erythematous rashes sometimes occur. Rarely erythema multiforme, Stevens-Johnson Syndrome and exfoliative dermatitis have been reported. In common with other beta-lactam antibiotics, angioedema and anaphylaxis have been reported.

Pregnancy & Lactation

Animal studies with orally and parenterally administered Co-amoxiclav have shown no teratogenic effect. The drug has been used orally in human pregnancy in a limited number of cases with no untoward effect; however, the use of Co-amoxiclav in pregnancy is not recommended unless considered essential by the physician. During lactation, trace quantities of Amoxicillin can be detected in breast milk.

Precautions & Warnings of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Co-amoxiclav should be used with care in patients on anticoagulation therapy or with severe hepatic dysfunction. In patients with moderate or severe renal impairment, dosage should be adjusted. During the administration of a high dose of Co-amoxiclav adequate fluid intake and urinary output should be maintained to minimize the possibility of crystalluria.

Use in Special Populations of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

The dose should be adjusted in case of patients with renal impairment

Adult:

  • Mild impairment (Creatinine clearance> 30ml/minute): No changein dosage.
  • Moderate impairment (Creatinine clearance 10-30 ml/minute): One 375 Tablet or one 625 Tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 12 hourly.
  • Severe impairment (Creatinine clearance <10 ml/minute): Not more than one 375 mg tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 24 hourly. Dialysis decreases serum concentrations of Moxaclav and an additional 0.6 gm IV dose may need to be given during dialysis and at the end of dialysis.

Children:

  • A similar reduction in dosage should be made for children.
  • Administration hepatic impairment: Dose with caution; monitor hepatic function at regular intervals.

Overdose Effects of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Problems of overdose with Co-amoxiclav are unlikely to occur, if encountered gastrointestinal symptoms and disturbance of the fluid and electrolyte balances may be evident. Co-amoxiclav may be removed from the circulation by haemodialysis.

Therapeutic Class of Tablet :-Moxaclav (500mg+125mg) As A ( Amoxacilline+Clavulanic Acid) (AS A Broad spectrum penicillins).

Raiyyan Tahsan. Date:25-01-2025 Saturday Time:9-56-45 PM

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