Each tablet contains:

Active substance(s):
Amoxicillin (as amoxicillin trihydrate)		40 mg
Clavulanic acid (as Potassium Clavulanate)		10 mg
Excipients:
Carmoisine Lake (E122)	0.245 mg

For a full list of excipients, see section Pharmaceutical Particulars

Tablet.

Round pink biconvex tablet with a score line and 50 embossed on opposing faces.

Dogs and cats.

Treatment of the following infections caused by b lactamase producing strains of bacteria sensitive to amoxicillin in combination with clavulanic acid:

It is recommended to carry out suitable tests for sensitivity testing when initiating the treatment. The treatment should only proceed if sensitivity is proven to the combination.

Do not use in animals with known hypersensitivity to penicillin or other substances of the beta-lactam group.

Do not use in rabbits, guinea pigs, hamsters or gerbils.

Do not use in animals with serious dysfunction of the kidneys accompanied by anuria and oliguria.

Do not use where resistance to this combination is known to occur.

Do not administer to horses and ruminating animals.

None.

Inappropriate use of the product may increase the prevalence of bacteria resistant to amoxicillin/clavulanic acid.

In animals with hepatic and renal failure, the dosing regimen should be carefully evaluated.

Use of the product should be based on susceptibility testing and take into account official and local antimicrobial policies. Narrow spectrum antibacterial therapy should be used for first line treatment where susceptibility testing suggests likely efficacy of this approach.

Caution is advised in the use in small herbivores other than those in section, "Contraindications".

Dogs and cats diagnosed with Pseudomonas infections should not be treated with this antibiotic combination.

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.

Hypersensitivity reactions unrelated to dose can occur with these agents.

Gastrointestinal symptoms (diarrhoea, vomiting) may occur after administration of the product.

Allergic reactions (e.g. skin reactions, anaphylaxia) may occasionally occur.

In case of occurrence of allergic reaction, the treatment should be withdrawn.

Studies in laboratory animals have not produced any evidence of teratogenic effects.

Use only according to the benefit/risk assessment by the responsible veterinarian.

Chloramphenicol, macrolides, sulfonamides and tetracyclines may inhibit the antibacterial effect of penicillins because of the rapid onset of bacteriostatic action. The potential for allergic cross-reactivity with other penicillins should be considered.

Penicillins may increase the effect of aminoglycosides.

Administration is via the oral route. The dosage rate is 12.5 mg combined actives/kg bodyweight twice daily. The tablets may be crushed and added to a little food.

The following table is intended as a guide to dispensing the product at the standard dose rate of 12.5 mg of combined actives per kg twice daily.

Bodyweight	Number of tablets twice daily
1-2	½
3-4	1
5-6	1.5
7-8	2
9-10	2.5
11-12	3
13-14	3.5
15-16	4
17-18	4.5

Acute cases: 5 to 7 days of treatment.

If no improvement is observed after 5 to 7 days, the diagnosis should be re-assessed.

Chronic or refractory cases: In these cases where there is considerable tissue damage, a longer course of therapy may be required so that it allows sufficient time for damaged tissue to repair.

If no improvement is observed after two weeks, the diagnosis should be re-assessed.

The product is of a low order of toxicity and is well tolerated by the oral route.

In a tolerance study in dogs a tested dose of 3 times the recommended dose of 12.5mg of the combined actives administered twice daily during 8 days did not demonstrate adverse effects.

In a tolerance study in cats a tested dose of 3 times the recommended dose of 12.5mg of the combined actives administered twice daily for 15 days did not demonstrate adverse effects.

Not applicable.

Pharmacotherapeutic group: Beta-lactam antibacterials, penicillins

ATCvet code: QJ01CR02

Amoxicillin is a beta-lactam antibiotic and its structure contains the beta-lactam ring and thiazolidine ring common to all penicillins. Amoxicillin shows activity against susceptible Gram-positive bacteria and Gram-negative bacteria.

Beta-lactam antibiotics prevent the bacterial cell wall from forming by interfering with the final stage of peptidoglycan synthesis. They inhibit the activity of transpeptidase enzymes, which catalyse cross-linkage of the glycopeptide polymer units that form the cell wall. They exert a bactericidal action but cause lysis of growing cells only.

Clavulanic acid is one of the naturally occurring metabolites of the streptomycete Streptomyces clavuligerus. It has a structural similarity to the penicillin nucleus, including possession of a beta-lactam ring. Clavulanic acid is a beta-lactamase inhibitor acting initially competitively but ultimately irreversibly. Clavulanic acid will penetrate the bacterial cell wall binding to both extracellular and intracellular beta-lactamases.

Amoxicillin is susceptible to breakdown by β-lactamase and therefore combination with an effective ß-lactamase inhibitor (clavulanic acid) extends the range of bacteria against which it is active to include β-lactamase producing species.

In vitro potentiated amoxicillin is active against a wide range of clinically important aerobic and anaerobic bacteria including:

Resistance is shown among Enterobacter spp, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. A trend in resistance of E. coli is reported.

Amoxicillin is well-absorbed following oral administration. In dogs the systemic bioavailability is 60-70%. Amoxicillin (pKa 2.8) has a relatively small apparent distribution volume, a low plasma protein binding (34% in dogs) and a short terminal half-life due to active tubular excretion via the kidneys. Following absorption the highest concentrations are found in the kidneys (urine) and the bile and then in liver, lungs, heart and spleen. The distribution of amoxicillin to the cerebrospinal fluid is low unless the meninges are inflamed.

Clavulanic acid (pK1 2.7) is also well-absorbed following oral administration. The penetration to the cerebrospinal fluid is poor. The plasma protein binding is approximately 25% and the elimination half-life is short. Clavulanic acid is heavily eliminated by renal excretion (unchanged in urine).

After oral administration of the recommended dose of 12.5mg combined actives/kg to dogs, the following parameters were observed: Cmax of 6.30 +/-0.45µg/ml, Tmax of 1.98 +/- 0.135h and AUC of 23.38 +/- 1.39 µg/ml.h for amoxicillin and Cmax of 0.87 +/- 0.1µg/ml, Tmax of 1.57 +/- 0.177hrs and AUC of 1.56 +/- 0.24mg/ml.h for clavulanic acid.

After oral administration of the recommended dose of 12.5mg combined actives/kg to cats, the following parameters were observed: Cmax of 7.12 +/-1.460 µg/ml, Tmax of 2.69 +/- 0.561 h and AUC of 33.54 +/- 7.335 µg/ml.h for amoxicillin and Cmax of 1.67 +/- 0.381 µg/ml, Tmax of 1.83 +/- 0.227 h and AUC of 7.03 +/- 1.493 µg/ml.h for clavulanic acid.

Not applicable.

Shelf-life of the veterinary medicinal product as packaged for sale:

18 months (blister packs), 6 months (tubs).

Do not store above 25°C. Store in the original package in order to protect from moisture.

The product is supplied in high-density polyethylene tubs with a polypropylene screw cap lid containing 100 tablets and in high-density polyethylene tubs with a polyethylene screw cap lid containing 500 tablets. A sachet of desiccant is included in each container. The product is also presented in packs containing 2, 10 and 50 blister strips (aluminium-aluminium) each containing 10 tablets per strip.

Not all pack sizes may be marketed.

Any unused product or waste material should be disposed of in accordance with national requirements.

Norbrook Laboratories Limited, Station Works, Camlough Road, Newry, Co. Down, BT35 6JP United Kingdom

08 March 2002

September 2023

Nil.