Dogs and cats.
Indications for use, specifying the target species
For the treatment of the following infections caused by β lactamase producing strains of bacteria sensitive to amoxicillin in combination with clavulanic acid and where clinical experience and/or sensitivity testing indicates the product as the drug of choice:
- Skin infections (including superficial and deep pyodermas) associated with Staphylococcus spp.
- Urinary tract infections associated with Staphylococcus spp, Streptococcus spp, Escherichia coli and Proteus mirabilis.
- Respiratory tract infections associated with Staphylococcus spp, Streptococcus spp and Pasteurella spp.
- Digestive tract infections associated with Escherichia coli.
- Infections of the oral cavity (mucous membrane) associated with Pasteurella spp, Streptococcus spp, Escherichia coli.
Do not use in animals with known hypersensitivity to penicillins or other susbstances of the β-lactam group or to any excipients.
Do not use in animals with serious dysfunction of the kidneys accompanied by anuria and oliguria.
Do not administer to gerbils, guinea pigs, hamsters, rabbits and chinchillas. Do not use in horses and ruminating animals.
Do not use where resistance to this combination is known to occur.
Special warnings for each target species
Special precautions for use
Special precautions for use in animals
Official, national and regional antimicrobial policies with respect to the use of broad-spectrum antibiotics should be taken into account. Do not use in case of bacteria sensitive to narrow spectrum penicillins or to amoxicillin as single substance. It is advised that upon initiating therapy appropriate sensitivity testing is performed and that therapy is continued only after susceptibility to the combination has been established. Use of the product deviating from the instructions given in the SPC may increase the prevalence of bacteria resistant to the amoxicillin/clavulanate, and may decrease the effectiveness of treatment with beta-lactam antibiotics.
In animals with hepatic and renal dysfunction, the dosing regimen should be carefully evaluated and the use of the product based on a risk/benefit evaluation by the veterinary surgeon.
Caution is advised in the use in small herbivores other than those in the section Contraindications.
The potential for allergic cross-reactions with other penicillin derivates and cephalosporins should be considered.
The chewable tablets are flavoured. In order to avoid any accidental ingestion, store tablets out of reach of the animals.
Special precautions to be taken by the person administering the veterinary medicinal product to animals
Penicillins and cephalosporins may cause hypersensitivity (allergy) following injection, inhalation, ingestion or skin contact. Hypersensitivity to penicillins may lead to cross-reactions to cephalosporins and vice versa. Allergic reactions to these substances may occasionally be serious. Do not handle this product if you know you are sensitised, or if you have been advised not to work with such preparations. Handle this product with great care to avoid exposure, taking all recommended precautions. If you develop symptoms following exposure such as a skin rash, you should seek medical advice and show the doctor this warning. Swelling of the face, lips or eyes or difficulty with breathing are more serious symptoms and require urgent medical attention. Wash hands after use.
Adverse reactions (frequency and seriousness)
Mild gastrointestinal signs (diarrhoea, and vomiting) have been reported in very rare cases after administration of the product. Treatment may be discontinued depending on the severity of the undesirable effects and a benefit/risk evaluation by the veterinary surgeon.
Allergic reactions (skin reactions, anaphylaxis) have been reported in very rare cases. In these cases, administration should be discontinued and a symptomatic treatment given.
Use during pregnancy, lactation or lay
Laboratory studies in rats and mice have not produced any evidence of teratogenic, foetotoxic or maternotoxic effects.
In pregnant and lactating animals, use only according to the benefit/risk assessment by the responsible veterinarian.
Interaction with other medicinal products and other forms of interaction
Chloramphenicol, macrolides, sulfonamides and tetracyclines may inhibit the antibacterial effect of penicillins because of the rapid onset of bacteriostatic action.
Penicillins may increase the effect of aminoglycosides.
Amounts to be administered and administration route
The recommended dose of the product is 10 mg amoxicillin / 2.5 mg clavulanic acid per kg body weight twice a day by the oral route in dogs and cats, according to the following tables:
Kesium 40mg/10mg chewable tablets for cats and dogs:
Number of 40mg/10mg tablets twice daily
>1 - 2
>2 - 4
>4 - 6
>6 - 8
Kesium 50mg/12.5mg chewable tablets for cats and dogs:
Number of 50mg/12.5mg tablets twice daily
>1.3 - 2.5
>2.6 - 5
>5.1 - 7.5
>7.6 - 10
Kesium 200mg/50mg chewable tablets for dogs:
Number of 200mg/50mg tablets twice daily
>2.6 - 5.0
>5.1 - 10.0
>10.1 - 15.0
>15.1 - 20.0
>20.1 - 25.0
>25.1 - 30.0
>30.1 - 35.0
>35.1 - 40.0
Kesium 400mg/100mg chewable tablets for dogs:
Number of 400mg/100mg tablets twice daily
>15 - 20
>20 - 25
Use Kesium 200mg/50mg tablets
>25 - 40
>40 - 60
>60 - 80
Kesium 500mg/125mg chewable tablets for dogs:
Number of 500mg/125mg tablets twice daily
>9 - 12.5
12.6 - 20
Use Kesium 200mg/50mg
20.1 - 25
25.1 - 37.5
37.6 - 50
50.1 - 62.5
62.6 - 75
In refractory cases the dose may be doubled to 20 mg of amoxicillin / 5 mg clavulanic acid/kg bodyweight twice daily, at the clinician’s discretion.
The chewable tablets are flavoured and are accepted by a majority of cats and dogs. The chewable tablets can be administered directly into the mouth of the animals or added to a small quantity of food.
Duration of therapy:
The majority of routine cases respond to 5 – 7 days of therapy. In chronic cases, a longer case of therapy is recommended. In such circumstances overall treatment length must be at the clinician’s discretion, but should be long enough to ensure complete resolution of the bacterial disease.
To ensure the correct dosage, body weight should be determined as accurately as possible to avoid under-dosing.
Instruction on how to divide the tablet: Put the tablet on an even surface, with its scored side facing down (convex face up). With the tip of the forefinger, exert slight vertical pressure on the middle of the tablet to break it along its width into halves. Then, in order to obtain quarters, exert slight pressure on the middle of one half with the forefinger to break it into two parts.
Overdose (symptoms, emergency procedures, antidotes), if necessary
In case of overdose diarrhoea, allergic reactions or further symptoms like central nervous excitation manifestations or cramps could appear. Symptomatic treatment should be initiated when necessary.