I try to tackle questions that I receive periodically and someone asked me the other day, “In your experience, does amoxicillin/clavulanate cause more diarrhea than amoxicillin?”
Amoxicillin and amoxicillin/clavulanate (Augmentin) can be used for numerous infections. Augmentin tends to be reserved for more severe infections or those that may have a higher likelihood of antibiotic resistance. If you remember your pharmacology, clavulanate binds bacterial beta-lactamases and helps facilitate the effectiveness of amoxicillin. But what about the side effects? Does Augmentin cause more diarrhea than amoxicillin?
The short and simple answer is yes. The package insert information for amoxicillin gives a percentage of 2% for diarrhea. The information from the Augmentin insert gives a range of 3-34%. This makes it critical to educate patients about this risk.
From my anecdotal experience in practice, the holds true as I have heard a greater number of significant complaints regarding diarrhea from patients who have taken Augmentin versus amoxicillin alone. With that said, this adverse effect does tend to be dose-dependent. If a patient is taking a higher dose of amoxicillin, they will be more likely to encounter GI adverse effects and diarrhea.
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I was told recently that daily doses greater than 100mg of clavulonic acid increase adverse effects without increasing effectiveness as a beta lactamase inhibitor. I haven’t had a chance to look into the data surrounding this. Have you heard any such things? It seems important given the widely variable formulations of augmentin, especially the suspensions.
I haven’t heard that specifically, but I think logically that makes a lot of sense. Higher dose, more adverse effects and there is probably a ceiling to the max effectiveness you can get out of the beta lactamase inhibitor. Haven’t heard what that specific dose or seen data on where that is however. – Thanks for sharing!