Amoxicillin / Clavulanic acid

He was on antibiotics.

He was on eardrops and Augmentin and was not getting better and developed these new symptoms.

And it just didn't feel right.

And so when we finally discovered what it was and I called ENT and we admitted him and gave him IV antibiotics and did all the things.

I am in pretty good shape right now.

So I chose to accept, when I went to the urgent care last week, they offered me Augmentin, which is basically it's amoxicillin with clavulanic acid.

Thank goodness I'm not penicillin allergic.

So I was able to take it, just a week's course of it.

And each time I took a pill, I took a pill of Saccharomyces boulardii.

And remember that Saccharomyces boulardii is the probiotic yeast that cannot be killed by your antibiotic as long as it doesn't have antifungal properties, which amoxicillin does not.

So Augmentin is amoxicillin plus clavulanic acid.

And amoxicillin is a beta-lactamase, and the clavulanic acid stops the beta-lactam from allowing bacteria to reproduce.

She was treated with sepharine.

Cefpotamexime, 100 milligram tablets in May, and Clavamox, 125 milligram tablets in July and September.

Pardon my pronunciation.

She scratches at her ear, shakes her head frequently, and yelps from the slightest touch of the ear.

And another question that I always like to ask is, were you taking other medications in the same family? Because a lot of times, even when I'm giving a patient consult and I look at the patient's chart, I find that patient recently took a related antibiotic.

Since we're talking about penicillin, I would have found, oh, just two months ago, the patient took Augmentin and tolerated it perfectly fine.

In fact, my mom recently had a similar experience.

She had an infection that required a fluoroquinolone, but she did have a reaction like 10, 15 years ago, or actually even more remote than that, to Levaquin.

Yeah.

Um, and, like, we didn't know we were gonna be able to get to, uh, a pharmacy, so I was like, "Can I just get, like, one more..." Uh, it was Augmentin was the oral antibiotic they gave me, and they're like, "No, we can't give out, like, like, we can't give out additional drugs here.

We, we don't have a pharmacy." And I was like, "Can you just, like, leave it on the table and maybe it'll go missing?" And [laughs] that's what they did, basically.

[laughs] Yeah.

So, so maybe, like, getting back to Denver and all that, like, h- how long did it take for you to actually be able to walk or even run?

run?It happened pretty quickly.

Um, I mean, that's the thing, nice thing about an infection is, like, antibiotics, especially a strong one like Augmentin, like, goes to work quick.

So, um, about three or four days after, which was only about two or so days home at that 'cause I was, you know, in, still in Lone Pine/California for almost two days, I started feeling better.

And I get these calls a lot.

Say you prescribed Augmentin for sinusitis, and the patient went to the pharmacy, and the pharmacy was closed.

You get a phone call and say, "Can you send this prescription to another pharmacist?" Like, for me as a physician who's like boarded in emergency medicine to like log back into Epic and like change the pharmac- [chuckles] change the pharmacy, pick a new pharmacy, and resend this Augmentin prescription, it's, it's a complete waste of my time.

You know? Definitely needs to happen.

Mm.

But that's something that a machine can do really easily.

Mm-hmm.

Uh, and just verify, are they s- still supposed to be on this Augmentin? Like do they, they, you know, like, and, and are they, uh, they-- do they have any allergies that they have like developed within like a day? Very unlikely, but this is something a machine can easily do, and this just helps me operate at the peak of my license taking care of really sick patients and not dealing with kind of like resending prescriptions to another pharmacy.

So just briefly some statistical considerations.

For that superiority comparison between Amox-Clav and Amox-Alone, 1,000 children needed to be randomly assigned one-to-one to those two intervention arms to provide, I think it was 81% power to detect an 8% absolute reduction in the primary outcome from what they assumed would be around 15%.

So they were assuming about 50% readmission in the amoxicillin group standard of care, essentially.

15% is what the readmission rate is with amox IV.

Because the emergency physician typed the note into free text during a trauma rush instead of clicking through administrative drop-down menus, the structured database field was completely blank.

The bot assumed no allergy existed, ignored three years of narrative doctor notes, and transmitted an electronic prescription for Augmentin straight to the local pharmacy.

In consumer software, an empty database field means a blank profile.

In enterprise healthcare, an empty database field combined with an unconstrained AI agent can close a patient's airway.

An agent that only queries clean database tables operates with massive clinical blind spots.

Second, absence of cross-reactivity awareness.

An unconstrained language model frequently fails to connect parent drug classes with brand name derivatives under real-world pressure, issuing Augmentin despite known amoxicillin sensitivities.

Third, premature right commitment.

It's just inflammation in the bladder that gives you symptoms like a UTI but without the bacteria.

So make sure you're doing your analysis with your doctor and finding bacteria to know that it's a bacterial UTI versus something you could just use anti-inflammatories for, okay? Mel: "We did ten days of Augmentin.

Uh, when should we retest the stool?" I don't know.

I'd give it two weeks, two weeks after you finish the Augmentin.

Jenny: "What do you-- supplements do you suggest for gut healing?" Well, that's a loaded question.

Number one, you gotta figure out what, what's unhealed in your gut, okay? Is it an infection? Start there.