아목시실린/클라불란산

항생제 - 강화 아미노페니실린

아목시실린/클라불란산(수의학에서 주로 **Clavamox®**라는 상품명으로 알려짐)은 매우 효과적이고 광범위한 **강화 아미노페니실린** 항생제입니다. * **항균 스펙트럼 확장:** 베타락타마제 억제제인 클라불란산이 추가되어 효소 분해로부터 아목시실린을 보호하며, 베타락타마제 생성 세균(예: 포도상구균, 대장균)을 포함하도록 항균 범위를 크게 확장합니다. * **임상적 유용성:** 개와 고양이의 요로 감염(UTI), 피부 및 연부 조직 감염, 치주 질환 치료용으로 FDA 승인을 받았습니다. * **경험적 선택:** 암컷 개의 세균성 방광염에 대한 훌륭한 1차 경험적 치료제이며, 플루오로퀴놀론과 병용 시 간담도 감염에도 사용됩니다. * **한계:** 클라불란산이 억제할 수 없는 제1형 세팔로스포리나제를 주로 생성하는 **녹농균(Pseudomonas aeruginosa)**이나 **엔테로박터(Enterobacter)** 종에는 일반적으로 **효과가 없습니다**.

작용 기전: **Amoxicillin** is a time-dependent, bactericidal antibiotic that binds to **Penicillin-Binding Proteins (PBPs)** → inhibits bacterial cell wall peptidoglycan cross-linking → compromises cell wall integrity → cell lysis and death. **Clavulanic acid** acts as a "suicide inhibitor" by competitively and irreversibly binding to **beta-lactamase enzymes** (types II, III, IV, V, and staphylococcal penicillinases) → prevents the enzymatic destruction of amoxicillin → restores and expands the antimicrobial spectrum against resistant organisms. *Note: There is little synergistic activity against organisms already susceptible to amoxicillin alone.*

동물 종별 용량

Cats

Susceptible infections · 62.5 mg/cat · PO · twice daily · do not exceed 30 days
Gram-positive infections · 10 mg/kg · PO · twice daily
Gram-negative infections · 20 mg/kg · PO · three times daily
Susceptible UTI's · 62.5 mg/cat (total dose) · PO · q12h · 10-30 days
Susceptible skin, soft tissue infections · 62.5 mg/cat (total dose) or 10-20 mg/kg · PO · q12h · 5-7 days
Susceptible sepsis, pneumonia · 10-20 mg/kg · PO · q8h · 7-10 days

Ferrets

Susceptible infections · 10-20 mg/kg · PO · 2-3 times daily

Birds

Susceptible infections · 50-100 mg/kg · PO · q6-8h
Susceptible infections (Ratites) · 10-15 mg/kg · PO · twice daily

Dogs

Susceptible infections · 13.75 mg/kg · PO · twice daily · do not exceed 30 days

투여 경로

금기

Patients with a history of hypersensitivity to penicillins
Small hindgut fermenters (rabbits, guinea pigs, chinchillas, hamsters) due to risk of fatal clostridial enterotoxemia
Oral administration in patients with septicemia, shock, or grave illness (due to delayed/diminished GI absorption)

이상반응

Gastrointestinal upset (anorexia, vomiting, diarrhea)
Hypersensitivity reactions (rashes, fever, eosinophilia, anaphylaxis)
Antibiotic-associated diarrhea and superinfections (due to altered gut flora)
Neurotoxicity (e.g., ataxia in dogs) at very high doses or prolonged use
Elevated liver enzymes (rare)
Tachypnea, dyspnea, edema, and tachycardia (rarely reported in dogs)

약물 상호작용

Bacteriostatic Antimicrobials (e.g., chloramphenicol, macrolides, tetracyclines, sulfonamides) · Theoretical in vitro antagonism; clinical importance is currently in doubt but historically not recommended to combine.
Methotrexate · Amoxicillin may decrease the renal excretion of methotrexate, causing increased levels and potential toxic effects.
Probenecid · Competitively blocks the tubular secretion of most penicillins, thereby increasing serum levels and serum half-lives.
Aminoglycosides · In vitro inactivation can occur if mixed together; serum concentrations of aminoglycosides may be falsely decreased if stored prior to analysis.

모니터링

Clinical efficacy (resolution of infection signs)
Adverse gastrointestinal signs (vomiting, diarrhea, anorexia)

과용량

Acute oral penicillin overdoses are unlikely to cause significant problems other than **gastrointestinal distress** (vomiting, diarrhea, anorexia). In humans, very high dosages of parenteral penicillins, especially in patients with underlying renal disease, have induced Central Nervous System (CNS) effects. Treatment of oral overdose should be supportive and symptomatic.

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