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Synermox 6.6 DRUG: SYNERMOX Synermox (Co-Amoxicav) is an antibiotic containing a combination of Amoxicillin and Clavulanic acid. The combination of drugs decreases the likelihood of penicillin resistance and increases the potential spectrum of bactericidal action. Indications and use: Indications: Infections due to beta-lactamase-producing strains (where Amoxicillin alone not appropriate). Use: Treatment of infections including cellulitis, animal bites, severe dental infection with spreading cellulitis, respiratory-tract infections, genito-urinary and abdominal infections. Dosage and administration: Oral dose: One tablet three times a day. Can be taken before, with or after food. Presentation: Synermox as a capsule / tablet containing Amoxicillin 500mg and Clavulanic acid 125mg. Contraindications: Allergy to penicillins Patients with a previous history of Co amoxiclav associated or penicillin associated jaundice or hepatic dysfunction or Porphyria. Warnings and precautions: As Amoxicillin is excreted to a large extent by the kidney, the dose or dose interval may need modification in patients with renal failure, as the half life in patients with renal failure is increased. Cholestatic jaundice has been identified as an adverse reaction occurring either during, or shortly after, the use of co-amoxiclav. An epidemiological study has shown that the risk of acute liver toxicity was about 6 times greater with co-amoxiclav than with Amoxicillin. Cholestatic jaundice is more common in patients above the age of 65 years and in males. Jaundice is usually self-limiting. Adverse effects: Allergic reactions may occur presenting as a pruritic skin rash or urticaria, fever, eosinophilia, joint pains, angioneurotic oedema, exfoliative dermatitis. Oral administration can cause gastro-intestinal symptoms such as diarrhoea, nausea, heartburn and colic, disturbances of electrolyte balance, which are dose-related and a result of local irritation. Contraceptives: may decrease the efficacy of oestrogen-containing oral contraceptives. Patients should use an additional contraceptive whilst taking a short course of Co-amoxiclav and for seven days after stopping the antibiotic. Interactions: Co-amoxiclav may enhance the effects of Warfarin. Information and advice for patients: Instruct patients to take all doses and complete course prescribed. If a skin rash occurs the patient should stop taking Synermox and seek medical advice. Lactation: Synermox is excreted in breast milk in trace amounts. Discuss with DEM consultant prior to prescription. References: eBNF – March 2002 No. 43 6.6