Optimizing Amoxicillin/Clavulanic Acid Dosing Regimens in Patients on Maintenance High-Flux Hemodialysis

Amoxicillin/clavulanic acid (AMC) is frequently prescribed in maintenance HD patients, mainly for treating community-acquired respiratory tract infections. As this β-lactam antibiotic exhibits a time-dependent killing, amoxicillin (AMX) concentrations exceeding the minimal inhibitory concentration (MIC) for at least 50% of treatment time are recommended,1 while clavulanic acid (CLA) concentrations should suffice to inhibit β-lactamases for a prolonged period of time.2 In patients with preserved kidney and hepatic function, pharmacokinetic studies revealed that total body clearance (CL) of AMX and CLA is comparable, allowing a fixed-dose drug combination.