IBA-Mentin 1000mg/62.5mg Pharbaco treatment for tonsillitis, sinusitis, bronchitis (2 blisters x 7 tablets)

Amoxicillin is a semi-synthetic antibiotic belonging to the Beta-Lactam family that has a broad bactericidal spectrum for many gram-positive and gram-negative bacteria due to the synthetic inhibition of bacterial cell walls. Amoxicillin is easily destroyed by beta-lactamase, so it has no effect on bacterial strains of these enzymes (multiple enzyme strains of enterobacteriaceae and haemophilus influenzae).

Clavulanic acid due to the fermentation of Streptomyces Clavuligerus, which has a beta-lactam structure similar to penicillin, is capable of inhibiting beta-lactamase due to the majority of Gram-negative bacteria and staphylococcus. In particular, Clavulanic Acid has a strong inhibition effect on beta-lactamase transmitted through plasmid, which resists penicillin and cephalosporins.

Pseudomonas Aeruginosa, Proteus Morganii and Rettgeri, some entobacter strains and providentia anti -drugs, and staphylococcus aure against this drug. Clavulanic acid itself has very weak antibacterial effects.

Clavulanic acid helps Amoxicillin not be destroyed by beta-lactamase, while expanding the antibacterial spectrum of amoxicillin effectively to many common bacteria that have resisted amoxicillin, resistant penicillins and other cephalosporins.

It is possible to see Amoxicillin and Clavulanate are bacteria for pneumoccus, streptococcus beta beta, staphylococcus (sensitive to penicillin is not affected by penicillinase), Haemophilus Influenzae and Branhamella Catatrhalis Beta-lactamase.

In summary, the antibacterial spectrum of the drug includes:

Gram -positive bacteria

Aerobic type: Streptococcus Faecalis, Streptococcus Pneumoniae, Streptococcus Pyogenes, Streptococcus Viridans, Staphylococcus aureus, Corynebacterium, Bacillus anthracis, Listeria monocytogenes.

Anaerobic type: Clostridium, peptococcus, peptostreptococcus.

Gram -negative bacteria

Aerobic type: Haemophilus Influenzae, Escherichia Coli, Proteus Mirabilis, Proteus vulgaris, Klebsiella, Salmonella, Shigella, Bordetella, Neisseria Gonorrhoeae, Neisseria Meningitidis, Vibrio Cholerae, Pasteurae Multocida.

Anaerobic type: Bacteroides including B.fragis.

resistance mechanism

Two main mechanisms to resist Amoxicillin/Acid Clavulanic include:

Stop acting because beta-lactamase bacteria are not inhibited by clavulanic acid, including groups B, C and D.

Change of penicillin -binding proteins, reducing the affinity of the drug to the goal.

The permeability of bacteria or pump mechanisms can cause or contribute to the resistance of bacteria, especially in gram -negative bacteria.

pharmacokinetic

absorption

Amoxicillin and Clavulanic acid are easy to absorb through oral.

The concentration of these two substances in the serum reaches up to 1–2 hours of medication. With a dose of 250 mg (or 500 mg), there will be 5 mcg/ml (or 8 - 9 mcg/ml) amoxicillin and about 3 mcg/ml of clavulanic acid in serum.

After 1 hour oral 20 mg/kg amoxicillin + 5 mg/kg Clavulanic acid, on average, there are 8.7 mcg/ml of amoxicillin and 3.0 mcg/ml of clavulanic acid in serum.

The absorption of the drug is not affected by food and it is best to take it right before meals. The oral bioavailability of amoxicillin is 90% and Clavulanic acid is 75%.

Distribution

Amoxicillin quickly distributed into most tissues and fluids in the body, except for brain tissue and cerebrospinal fluid, but when the meninges are inflamed, amoxicillin is easily in. The percentage of drugs associated with plasma protein is 17-20%.

Metabolism

Amoxicillin is partially converted into penicilloic acid without antibacterial activity.

Elimination

55 - 70% amoxicillin and 30-40% clavulanic acid are discharged through urine in activity. Probenecid extends Amoxicillin's elimination time but does not affect the elimination of clavulanic acid.

Amoxicillin's waste time in serum is 1-2 hours, of Clavulanic Acid is about 1 hour. In patients with 9 ml/minute creatinine clearance, Amoxicillin and Clavulanic Acid is 7.5 and 4.3 hours respectively.

Caution when using

for patients with manifestation of liver dysfunction, signs and symptoms of cholestasis jaundice, but rarely occurs when taking the drug but may be severe. However, these symptoms are often recovered and will end after 6 weeks of stopping treatment.

For average or severe kidney failure, attention should be paid to the dosage.

For patients with a history of hypersensitivity to penicillin may have severe or death reactions.

Be cautious for patients with a history of redness and lymphadenopathy when taking amoxicillin.

Taking drugs for prolonged drugs sometimes develops resistant bacteria.

The ability to drive and operate machinery

There is no evidence of the effect of the drug on the ability to drive and operate machinery.

Pregnancy

Experimental research on the reproductive process of mice proved when using oral preparations and injections are not deformed. However, because there is little experience in using drugs during pregnancy, it is necessary to avoid using drugs in pregnant women, especially in the first 3 months, except for the necessary case prescribed by the doctor.

Breastfeeding period

During breastfeeding, can use preparations. The drug is not harmful to breastfeeding, unless there is a risk of sensitivity due to a very small amount of medicine in milk.

Medicinal interaction

The drug can cause prolonged melting and blood clotting time. Therefore, it is necessary to be careful for patients being treated with anticoagulants.

As other broad-spectrum antibiotics, IBA-Mentin reduces the effectiveness of oral contraceptives, so it is necessary to notify the patient in advance.

methotrexate: penicillin can reduce the secretion of methotrexate, increasing the risk of poisoning.

Probenecid: Do not use the drug simultaneously with Probenecid. Probenecid reduces the secretion of amoxicillin in the renal tubules. Using the drug simultaneously with probenecid can cause increased and prolonged the concentration of amoxicillin in the blood.

Mycophenolate Mofetil: In patients with Mycophenolate Mofetil, the drug causes about 50% of the concentration of metabolic metabolites of mycophenolic acid (MPA) of the previous dose after starting to use amoxicillin in combination with oral clavulanic acid. The change in the previous dose level may not accurately reflect the changes in the general exposure of MPA. Therefore, changes in doses of Mycophenolate Mofetil are often unnecessary in the absence of clinical evidence of graft dysfunction. However, clinical monitoring should be closely monitored during the combination process and a short time after treatment with antibiotics.