amoxycillin/clavulanate / Generic mfg. - LARVOL DELTA

Associations Between Early-Life Exposure to Different Antibiotic Agents and the Risks of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Study. (PubMed, Pharmaceutics) - "For ADHD, exposure to amoxicillin/clavulanic acid, cefixime, ampicillin, and ampicillin/sulbactam was associated with increased risk, whereas erythromycin, cephalexin, and sulfamethoxazole-trimethoprim were associated with reduced risk (all p < 0.047). Associations between early-life antibiotic exposure and the risks of ASD and ADHD varied according to antibiotic agents, route of administration, and timing of exposure. These findings may help explain inconsistencies among previous studies and inform antibiotic prescribing during infancy."

Journal • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • Autism Spectrum Disorder • CNS Disorders • Genetic Disorders • Psychiatry

Increased Prevalence of Multidrug-Resistant Escherichia coli as an Adverse Effect of Excessive Antibiotic Use in a Tertiary Care Hospital in Serbia. (PubMed, Life (Basel)) - "Total antibiotic consumption remained stable, with no correlation between consumption and MDR isolation rates, although ampicillin resistance increased significantly. Compared with 2015, resistance significantly increased to amoxicillin-clavulanic acid, cefotaxime, cefepime, ceftazidime, ciprofloxacin, and levofloxacin, while ceftriaxone resistance decreased. The blaCTX-M gene was detected in 53% of bloodstream isolates, indicating widespread dissemination of ESBL-producing E. coli and highlighting the need for continuous surveillance and antimicrobial stewardship."

Adverse events • Journal • Infectious Disease

A Bacillus pretiosus Biofertilizer Enhances Early Growth, Nutritional Profile, and Rhizospheric Dynamics in Quercus Species for Forest Restoration. (PubMed, Life (Basel)) - "Phenotypic profiling of the resistome by cenoantibiogram did not confirm an increase in resistance to antibiotics at the community level, instead showing a significant reduction in the minimum inhibitory concentration (MIC) for imipenem and amoxicillin/clavulanic acid under the fertigation of effluents. Together, these findings demonstrate that combining effluents valued with p > 0.05 B. pretiosus C1 shows a consistent functional profile with a high-value biotechnological agent, improving the biometric and nutritional status of seedlings without altering the stability of the soil microbial community. This supports its potential application as a safe biofertilizer candidate within forest restoration strategies and One Health, although more prospective field trials will be needed to validate each site."

Journal

Appendicular Versus Non-Appendicular Community-Acquired Intra-Abdominal Infections: A Post-Hoc Analysis of the PERICOM Multicenter Study. (PubMed, Antibiotics (Basel)) - "Amoxicillin-clavulanic acid plus gentamicin covered the isolates of 92% of patients versus 61% for third-generation cephalosporin plus metronidazole (p < 0.001), a difference identical in both appendicular and non-appendicular sites. Appendicular and non-appendicular CA-IAIs appear to be distinct entities, supporting stratified management. Future guidelines should consider site-specific strategies, therapeutic individualization, and the integration of CA-IAI ecology."

Clinical • Journal • Retrospective data • Gastroenterology • Gastrointestinal Disorder • Infectious Disease

Delafloxacin Resistance and MIC-Distribution in Ciprofloxacin-Resistant Enterobacterales: A Retrospective Evaluation of Minimum Inhibitory Concentrations. (PubMed, Antibiotics (Basel)) - "For the majority of isolates (64%), other oral options for antibiotic therapy, such as amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole, were still available. Our data suggests that, compared to CIP, DFX does not demonstrate increased in vitro efficacy against fluoroquinolone-resistant Enterobacterales. Subsequent DFX testing seems to be of limited additional value."

Journal • Retrospective data • Infectious Disease

Antibiograms generated in the United States support use of potentiated sulfonamides and intravenous amoxicillin-clavulanic acid when antimicrobials are needed in Escherichia coli canine pyometra. (PubMed, J Am Vet Med Assoc) - "Among E coli isolates, poor susceptibility was observed to penicillins, β-lactam/β-lactamase inhibitor combinations, tetracyclines, and chloramphenicol. These antibiograms suggest that folate-pathway inhibitors could be effective empiric choices that align with antimicrobial stewardship principles. High-exposure intravenous amoxicillin-clavulanic acid could be an effective choice in regions where the product is available."

Journal

Potential clinical implications due to essential differences in antimicrobial susceptibility profiles of actinomycetoma causative agents of the Actinomadura, Nocardia and Streptomyces genera towards commonly used anti-actinomycetoma drugs. (PubMed, J Antimicrob Chemother) - "Clear differences in antimicrobial susceptibility patterns were noted for the different actinomycetoma causative agents, indicating that actinomycetoma treatment should be tailored to the causative agent."

Journal • Oncology

Beyond the Cumulative Antibiogram: A Weighted-Incidence Syndromic Combination Antibiogram to Guide Empirical Therapy of Bloodstream Infections in the Emergency Department. (PubMed, Infect Dis Ther) - "WISCA complements the cAST by providing regimen-level, syndrome- and subgroup-specific coverage estimates, capturing pathogen diversity missed by species-threshold cAST reporting. Integrating WISCA into local antimicrobial-stewardship programs may refine empirical treatment choices for ED bacteremia, especially according to the BSI source and patient-specific characteristics, while supporting judicious use of broad-spectrum agents."

Journal • Infectious Disease • Nephrology

Portal Venous Gas and Emphysematous Gastritis: An Uncommon Consequence of Upper Endoscopy (ACG 2026) - "She received bowel rest, total parenteral nutrition, PPI therapy, and broad-spectrum antimicrobials (meropenem, vancomycin, fluconazole)...She was discharged on amoxicillin-clavulanate, with complete endoscopic resolution seen at three month follow up...Surgical intervention should be reserved for clinical deterioration, perforation, or confirmed necrosis. Figure: CT images showing emphysematous gastritis (blue arrow) and portal venous gas (orange arrow) Figure: Endoscopic appearance of stomach on presentation, day 3, and at 3 months"

Cardiovascular • Dyspepsia • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hypertension • Hypotension • Pulmonary Disease • Respiratory Diseases

Recurrent Pyogenic Liver Abscess Unmasking an Occult Duodeno-Hepatic Fistula: A Rare and Delayed Complication of Necrotizing Pancreatitis (ACG 2026) - "Over three years, he had multiple admissions for recurrent hepatic abscess requiring repeated drainage and prolonged antibiotics (ertapenem, amoxicillin-clavulanate). Chapter 6. Figure: Endoscopy showing duodenal fistula with pus Figure: CT abdomen with IV contrast showing liver abscess with air bubble"

Cardiovascular • Crohn's disease • Dyslipidemia • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Hypertriglyceridemia • Immunology • Infectious Disease • Inflammatory Bowel Disease • Pancreatitis • Peptic Ulcer • Thrombosis

Suspected Infected Renal Cyst in Autosomal Dominant Polycystic Kidney Disease Presenting With Predominant Gastrointestinal Symptoms (ACG 2026) - "Given ADPKD with flank pain, urinary findings, systemic illness, nondiagnostic imaging, and gastrointestinal symptoms potentially confounded by PLD, suspected infected renal cyst versus complicated urinary tract infection was treated with intravenous ciprofloxacin...Antibiotics were transitioned to oral amoxicillin-clavulanate to complete a 14-day course...Clinicians should maintain a high index of suspicion for renal cyst infection in patients with ADPKD who present with gastrointestinal symptoms, flank pain, urinary abnormalities, and systemic illness. Figure: Axial noncontrast CT abdomen demonstrating extensive polycystic liver disease with innumerable hepatic cysts in a patient with autosomal dominant polycystic kidney disease, contributing to diagnostic overlap with gastrointestinal and hepatobiliary etiologies."

Acute Kidney Injury • Autosomal Dominant Polycystic Kidney Disease • Cardiovascular • Chronic Kidney Disease • Genetic Disorders • Hematological Disorders • Hepatology • Hypertension • Infectious Disease • Metabolic Disorders • Nephrology • Polycystic Kidney Disease • Renal Disease

Unremarkable Imaging, Remarkable Inflammation: EBV-Triggered HLH Masquerading as Acute Liver Injury in a Young Woman (ACG 2026) - "Case Description/ A 21-year-old woman with no significant medical history presented with persistent high-grade fevers, nausea, and vomiting after initially being treated for presumed urinary tract infection with amoxicillin-clavulanate...This case highlights how EBV-triggered HLH may present predominantly as acute liver injury despite negative structural hepatobiliary evaluation, including MRCP. Persistent fevers and progressive liver injury despite unrevealing imaging should prompt consideration of HLH to avoid delayed recognition and multiorgan dysfunction."

Clinical • Epstein-Barr Virus Infections • Gastrointestinal Disorder • Hemophagocytic lymphohistiocytosis • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Rare Diseases • IL2

Profound Hepatocellular Liver Injury in a 26-Year-Old With Concomitant Intrahepatic Cholestasis of Pregnancy (ICP): A Diagnostic Conundrum (ACG 2026) - "Course complicated by worsening LFTs (AST 203/ALT 489â AST 2,244 /ALT 2,725/ALP 175), impaired synthetic function (INR 1.5, albumin 2.7, T bilirubin 2.3) & BA elevation (99 µmol/L)...Given concerns for overlapping drug-induced liver injury (DILI) & intrahepatic cholestasis of pregnancy (ICP), ursodeoxycholic acid & N-acetylcysteine (NAC) were started...Amoxicillin-clavulanate is the most common cause of idiosyncratic DILI in the US and accounts for 11% of cases...D. Portal tracts showing no significant inflammation; favoring a non-infectious etiology"

Autoimmune Hepatitis • Cholestasis • Genetic Disorders • Gynecology • Hepatology • Immunology • Inflammation • Liver Failure • Urticaria • ABCB1

Role of Endoscopy in Adequate Drainage and Management of Post-Surgical Duodenal Perforation (ACG 2026) - "Interventional radiology (IR) placed a percutaneous drain, and he was discharged on amoxicillin-clavulanate...(C). Pigtail stent placement."

Brewing Trouble: A Rare Complication of Antibiotic-Induced Intestinal Dysbiosis (ACG 2026) - "Further investigation revealed that symptoms including epigastric pain, nausea, emesis, ataxia, dysarthria, and lethargy began after prolonged antibiotic exposure with amoxicillin-clavulanate and ciprofloxacin and were predominant after carbohydrate-rich meals...Our case presents a negative carbohydrate challenge test despite typical presentation, which could be associated with disruption of interactions from ethanol production and phenazines between Candida species and P. aeruginosa biofilm production by fluconazole treatment...Prolonged antibiotic exposure may disrupt normal gut microbiota, leading to intestinal dysbiosis and overgrowth of fermenting organisms, including yeasts such as Saccharomyces and Candida species, as well as bacteria such as Pseudomonas aeruginosa. In this altered microbial environment, dietary carbohydrates are metabolized to glucose and subsequently fermented into ethanol, which is absorbed enterically and can result in endogenous alcohol..."

Dysbiosis • Ataxia • CNS Disorders • Movement Disorders • Otorhinolaryngology • Pancreatitis • Respiratory Diseases • Sinusitis

Comorbidity With SIBO in IBS Is Associated With Lower Acute Healthcare Utilization Despite Markedly Higher Targeted Antibiotic Use: A Propensity Score-Matched Real-World Analysis (ACG 2026) - "Outcomes at 0â90, 91â180, and 181â365 days included hospitalizations, emergency department (ED) visits, and use of rifaximin, metronidazole, and amoxicillin/clavulanate. Prior to PSM, IBS-SIBO patients carried a higher comorbidity burden, including gastroparesis (7.8% vs. 1.8%), hypothyroidism (19.2% vs. 12.0%), and greater baseline medication exposure."

Clinical • HEOR • Real-world • Real-world evidence • Endocrine Disorders • Gastrointestinal Disorder

First Report of Intra-Procedural Cone-Beam CT Guiding Management of a Paraesophageal Sinus Tract (ACG 2026) - "Endoscopic closure was deferred, and the tract was irrigated with dilute gentamicin followed by a 14-day course of amoxicillin-clavulanate. Figure: Figure 1. Intra-procedural cone-beam CT evaluation of the proximal paraesophageal sinus tract, Cone-beam CT images obtained during advanced endoscopic evaluation demonstrate opacification of a proximal esophageal, paraesophageal tract extending posteriorly into the paraesophageal mediastinal space."

Atrial Fibrillation • Cardiovascular • Gastrointestinal Disorder • Infectious Disease

A DrugâDrug Interaction Gone Pancreatic: Clindamycin and Antiseizure Medication Toxicity (ACG 2026) - "Recent history was notable for treatment of a dental abscess with amoxicillin/clavulanate, transitioned to clindamycin on the day symptoms began. Home medications included lamotrigine, carbamazepine, and hydrochlorothiazide (HCTZ). Given the potential interaction between clindamycin and carbamazepine resulting in elevated carbamazepine exposure and drug-induced pancreatitis, clindamycin and HCTZ were discontinued, and ampicillin/sulbactam was initiated...This case highlights the importance of recognizing drug-drug interactions as an overlooked cause of pancreatitis and carefully evaluating new medications in patients receiving chronic pharmacotherapy to prevent avoidable adverse events. Figure: Figure 1: CT abdomen/pelvis with IV contrast findings of acute pancreatitis with ill-defined hypoenhancing pancreatic parenchyma to level of the body."

CNS Disorders • Dental Disorders • Depression • Epilepsy • Gastroenterology • Gastroesophageal Reflux Disease • Immunology • Neuralgia • Pancreatitis

Scleroderma, Stasis, and Sarcina: A Rare Gastric Infection in Systemic Sclerosis (ACG 2026) - "Case Description/ A 70-year-old woman with systemic sclerosis complicated by esophageal aperistalsis, and chronic use of methadone and trazodone presented with progressive dysphagia and reflux...She was treated with amoxicillin-clavulanate, high-dose proton pump inhibitor, and prucalopride as a prokinetic agent...Although ciprofloxacin plus metronidazole is the most commonly reported regimen, no formal treatment guidelines exist. In vitro susceptibility data suggest efficacy of penicillins, fluoroquinolones, macrolides, and tetracyclines. Our use of amoxicillin-clavulanate to avoid QT prolongation risk represents a novel therapeutic approach. This case highlights the importance of evaluating for underlying causes of delayed gastric emptying when S. ventriculi is detected, the variable clinical spectrum of this organism, and the role of individualized antibiotic selection when standard regimens are contraindicated."

Gastrointestinal Disorder • Immunology • Infectious Disease • Respiratory Diseases • Scleroderma • Systemic Sclerosis

Drug-Induced Liver Injury From Amoxicillin-Clavulanate Progressing to Acute Liver Failure in a Young Woman (ACG 2026) - "Figure: Table 1 - Causality assessment using the Roussel Uclaf Causality Assessment Method (RUCAM) framework supports a "highly probable" attribution to AC. Key elements include: compatible latency (symptoms began within weeks of the first AC course), exclusion of competing etiologies (negative viral hepatitis panel, negative autoimmune serologies, negative ceruloplasmin, negative tissue stains for infectious organisms, imaging without persistent biliary obstruction after stone extraction), characteristic biopsy findings, and clinical worsening after inadvertent rechallenge with the second AC course."

Clinical • Cholestasis • CNS Disorders • Gastroenterology • Hematological Disorders • Hepatology • Hypoglycemia • Immunology • Infectious Disease • Inflammation • Liver Failure • Thrombocytopenia • ALK

The Hepatitis That Wouldn't Go Away: Autoimmune Hepatitis Unmasked After Amoxicillin-Clavulanate Exposure (ACG 2026) - "He additionally developed hepatic encephalopathy requiring lactulose. Prednisone was restarted, and azathioprine therapy was planned...While the patient initially responded to corticosteroids, relapse after steroid withdrawal, subsequent ANA positivity, and the need for ongoing immunosuppression favored unmasking or triggering of underlying AIH rather than a self-limited autoimmune-like drug reaction. Early recognition and long-term follow-up are essential, as disease recurrence may warrant maintenance immunosuppressive therapy."

Autoimmune Hepatitis • Cardiovascular • CNS Disorders • Diabetes • Fibrosis • Hepatic Encephalopathy • Hepatology • Hypertension • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Respiratory Diseases

Masquerading as Malignancy: Pyogenic Liver Abscesses With Pylephlebitis Mimicking Metastatic Cholangiocarcinoma and Hepatocellular Carcinoma (ACG 2026) - "He was placed on Lovenox and empiric Piperacillin-Tazobactam for diverticulitis...Patient was subsequently treated with one week of Piperacillin-Tazobactam followed by 2 weeks of Amoxicillin-Clavulanate with resolution of symptoms...Patient remains anticoagulated with Apixaban with planned follow-up MRI and colonoscopy to evaluate for occult colon pathology...Figure: Table depicting labs obtained during hospitalization. Figure: Pre-biopsy and during percutaneous CT-guided segment 3 hepatic lesion biopsy imaging"

Metastases • Biliary Cancer • Cholangiocarcinoma • Gastrointestinal Disorder • Genito-urinary Cancer • Hepatocellular Cancer • Hepatology • Infectious Disease • Liver Cancer • Oncology • Prostate Cancer • Solid Tumor • Thrombosis

From Bacteremia to Dual-Organ Transplant: Streptococcus Intermedius Liver Abscesses Complicated by Portal Vein Thrombosis, Non-Cirrhotic Portal Hypertension, and Hepatorenal Syndrome (ACG 2026) - "He received ertapenem followed by prolonged oral amoxicillin-clavulanate and linezolid, and started on apixaban on discharge for PVT...A) Coronal T2-weighted fat-suppressed MRI sequence with a few dilated venous collaterals along the main portal vein (red circle) and two liver parenchyma T2 hyperintensities, consistent with pyogenic liver abscesses (light blue circles). B) 12-week coronal T2-weighted fat-suppressed MRI sequence, with interval resolution of the liver abscesses, but increased size and number of venous collaterals, consistent with cavernous transformation of portal vein (circle in red), and worsening ascites."

Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Diabetic Nephropathy • Fibrosis • Heart Failure • Hepatology • Hypertension • Immunology • Infectious Disease • Liver Failure • Metabolic Disorders • Nephrology • Portal Hypertension • Renal Disease • Septic Shock • Solid Organ Transplantation • Thrombosis • Transplantation • Type 2 Diabetes Mellitus

A Rare Culprit: Amoxicillin-Induced Seronegative Autoimmune Hepatitis (ACG 2026) - "While several drugs including amoxicillin-clavulanate have been reported to cause DILI, isolated amoxicillin-induced DI-AIH is exceedingly rare and not well-described...Ursodiol was discontinued on day 29 after biochemical improvement, and a gradual prednisone taper was initiated with reduction in prednisone by 10mg every week until discontinuation (purple-shaded region). Peak total bilirubin reached 17.9 mg/dL prior to therapy, followed by rapid improvement in bilirubin and liver enzyme levels after treatment initiation, with complete biochemical normalization during follow-up at 88 days. The temporal relationship between drug withdrawal, corticosteroid therapy, and sustained biochemical recovery supports the diagnosis of amoxicillin-induced seronegative drug-induced autoimmune hepatitis."

Autoimmune Hepatitis • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Pruritus • Solid Tumor

A Fungal Sequela of Biliary Intervention: Candida Pyogenic Liver Abscess in Pancreatic Malignancy (ACG 2026) - "He received 1st cycle of palliative gemcitabine/paclitaxel 6 days prior to presentation...He received IV fluids, blood cultures were obtained, and broad-spectrum antimicrobial therapy with vancomycin, meropenem, and micafungin was initiated...Micafungin was restarted and ceftriaxone was continued. On discharge, antimicrobials were changed to oral fluconazole, and amoxicillin/clavulanate...Figure: CT Abdomen Pelvis with and without contrast remarkable for hypodense collection containing foci of gas in the caudate lobe 4.5 x 3 cm concerning for abscess, splenomegaly, portal vein thrombosis. Figure: MRI Abdomen Pelvis with and without contrast remarkable for caudate lobe abscess, progressive multifocal cholangitis, and multifocal intrahepatic dilated biliary radicles/developing abscesses."

Biliary Cancer • Cardiovascular • Diabetes • Hepatology • Hypotension • Infectious Disease • Metabolic Disorders • Oncology • Pancreatic Adenocarcinoma • Septic Shock • Thrombosis • Type 2 Diabetes Mellitus