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Label: AMOXICILLIN AND CLAVULANATE POTASSIUM tablet, film coated
AMOXICILLIN AND CLAVULANATE POTASSIUM powder, for suspension
AMOXICILLIN AND CLAVULANATE POTASSIUM tablet, chewable
NDC Code(s): 0781-1619-66, 0781-1643-66, 0781-1831-13, 0781-1831-20, view more
0781-1852-13, 0781-1852-20, 0781-1874-31, 0781-6102-46, 0781-6104-46
Packager: Sandoz Inc
These highlights do not include all the information needed to use AMOXICILLIN AND CLAVULANATE POTASSIUM safely and effectively. See full prescribing information for AMOXICILLIN AND CLAVULANATE POTASSIUM.
AMOXICILLIN and CLAVULANATE POTASSIUM tablets, oral suspension and chewable tablets for oral use
To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by bacteria.
Amoxicillin and clavulanate potassium tablets, oral suspension and chewable tablets are a combination penicillin-class antibacterial and beta-lactamase inhibitor indicated for treatment of the following:
Lower respiratory tract infections (1.1)
Acute bacterial otitis media (1.2)
Sinusitis (1.3)
Skin and skin structure infections (1.4)
Urinary tract infections (1.5)
Adults and Pediatric Patients > 40 kg: 500 or 875 mg every 12 hours or 250 or 500 mg every 8 hours. (2.1, 2.2)
Pediatric patients aged 12 weeks (3 months) and older: 25 to 45 mg/kg/day every 12 hours or 20 to 40 mg/kg/day every 8 hours, up to the adult dose. (2.2)
Neonates and infants < 12 weeks of age: 30 mg/kg/day divided every 12 hours, based on the amoxicillin component. Use of the 125 mg/5 mL oral suspension is recommended. (2.2)
Formulations and amoxicillin/clavulanate content are:
Tablets: 250 mg/125 mg, 500 mg/125 mg, 875 mg/125 mg; 875 mg/125 mg tablets are scored (3)
For Oral Suspension: 200 mg/28.5 mg per 5 mL, 400 mg/57 mg per 5 mL (3)
Chewable Tablets: 200 mg/28.5 mg, 400 mg/57 mg (3)
History of a serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin and clavulanate potassium or to other beta-lactams (e.g., penicillins or cephalosporins) (4)
History of cholestatic jaundice/hepatic dysfunction associated with amoxicillin and clavulanate potassium. (4)
Serious (including fatal) hypersensitivity reactions: Discontinue amoxicillin and clavulanate potassium if a reaction occurs. (5.1)
Hepatic dysfunction and cholestatic jaundice: Discontinue if signs/symptoms of hepatitis occur. Monitor liver function tests in patients with hepatic impairment. (5.2)
Clostridium difficile-associated diarrhea (CDAD): Evaluate patients if diarrhea occurs. (5.3)
Patients with mononucleosis who receive amoxicillin and clavulanate potassium develop skin rash. Avoid amoxicillin and clavulanate potassium use in these patients. (5.4)
Overgrowth: The possibility of superinfections with fungal or bacterial pathogens should be considered during therapy. (5.5)
The most frequently reported adverse effects were diarrhea/loose stools (9%), nausea (3%), skin rashes and urticaria (3%), vomiting (1%) and vaginitis (1%) (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Sandoz Inc. at 1-800-525-8747 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch
Co-administration with probenecid is not recommended. (7.1)
Concomitant use of amoxicillin and clavulanate potassium and oral anticoagulants may increase the prolongation of prothrombin time. (7.2)
Co-administration with allopurinol increases the risk of rash. (7.3)
Amoxicillin and clavulanate potassium may reduce efficacy of oral contraceptives. (7.4)
Pediatric Use: Modify dose in patients 12 weeks or younger. (8.4)
Renal impairment; Dosage adjustment is recommended for severe renal impairment (GFR< 30mL/min). (2.3, 8.6)
1.1 Lower Respiratory Tract Infections
1.2 Acute Bacterial Otitis Media
1.3 Sinusitis
1.4 Skin and Skin Structure Infections
1.5 Urinary Tract Infections
1.6 Limitations of Use
2.1 Adults
2.2 Pediatric Patients
2.3 Patients with Renal Impairment
2.4 Directions for Mixing Oral Suspension
4.1 Serious Hypersensitivity Reactions
4.2 Cholestatic Jaundice/Hepatic Dysfunction
5.1 Hypersensitivity Reactions
5.2 Hepatic Dysfunction
5.3 Clostridium difficile Associated Diarrhea
5.4 Skin Rash in Patients with Mononucleosis
5.5 Potential for Microbial Overgrowth
5.6 Phenylketonurics
5.7 Development of Drug-Resistant Bacteria
6.2 Post-Marketing Experience
7.1 Probenecid
7.2 Oral Anticoagulants
7.3 Allopurinol
7.4 Oral Contraceptives
7.5 Effects on Laboratory Tests
8.2 Labor and Delivery
8.6 Dosing in Renal Impairment
12.4 Microbiology
14.1 Lower Respiratory Tract and Complicated Urinary Tract Infections
14.2 Acute Bacterial Otitis Media and Diarrhea in Pediatric Patients
17.1 Information for Patients
To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and clavulanate potassium and other antibacterial drugs, amoxicillin and clavulanate potassium should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Amoxicillin and clavulanate potassium tablets, oral suspension and chewable tablets are a combination penicillin-class antibacterial and beta-lactamase inhibitor indicated in the treatment of infections due to susceptible isolates of the designated bacteria in the conditions listed below:
Caused by beta-lactamase–producing isolates of Haemophilus influenzae and Moraxella catarrhalis.
Caused by beta-lactamase–producing isolates of H.influenzae and M.catarrhalis.
Caused by beta-lactamase producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species.
Caused by beta-lactamase producing isolates of E.coli, Klebsiella species, and Enterobacter species.
When susceptibility test results show susceptibility to amoxicillin, indicating no beta-lactamase production, amoxicillin and clavulanate potassium should not be used.
Amoxicillin and clavulanate potassium may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when amoxicillin and clavulanate potassium is administered at the start of a meal. To minimize the potential for gastrointestinal intolerance, amoxicillin and clavulanate potassium should be taken at the start of a meal.
The usual adult dose is one 500 mg tablet of amoxicillin and clavulanate potassium every 12 hours or one 250 mg tablet of amoxicillin and clavulanate potassium every 8 hours. For more severe infections and infections of the respiratory tract, the dose should be one 875 mg tablet of amoxicillin and clavulanate potassium every 12 hours or one 500 mg tablet of amoxicillin and clavulanate potassium every 8 hours. Adults who have difficulty swallowing may be given the 125 mg/5 mL or 250 mg/5 mL suspension in place of the 500 mg tablet. The 200 mg/5 mL suspension or the 400 mg/5 mL suspension may be used in place of the 875 mg tablet.
Two 250 mg tablets of amoxicillin and clavulanate potassium should not be substituted for one 500 mg tablet of amoxicillin and clavulanate potassium. Since both the 250 mg and 500 mg tablets of amoxicillin and clavulanate potassium contain the same amount of clavulanic acid (125 mg, as the potassium salt), two 250 mg tablets are not equivalent to one 500 mg tablet of amoxicillin and clavulanate potassium.
The 250 mg tablet of amoxicillin and clavulanate potassium and the 250 mg chewable tablet should not be substituted for each other, as they are not interchangeable. The 250 mg tablet of amoxicillin and clavulanate potassium and the 250 mg chewable tablet do not contain the same amount of clavulanic acid (as the potassium salt). The 250 mg tablet of amoxicillin and clavulanate potassium contains 125 mg of clavulanic acid, whereas the 250 mg chewable tablet contains 62.5 mg of clavulanic acid.
Based on the amoxicillin component, amoxicillin and clavulanate potassium should be dosed as follows:
Neonates and Infants Aged <12 weeks (<3 months)
The recommended dose of Amoxicillin and clavulanate potassium is 30 mg/kg/day divided every 12 hours, based on the amoxicillin component. Experience with the 200 mg/5 mL formulation in this age group is limited, and thus, use of the 125 mg/5 mL oral suspension is recommended.
Patients Aged 12 weeks (3 months) and Older
See dosing regimens provided in Table 1. The every 12 hour regimen is recommended as it is associated with significantly less diarrhea [see Clinical Studies (14.2)]. However, the every 12 hour suspension (200 mg/5 mL and 400 mg/5 mL) and chewable tablets (200 mg and 400 mg) contain aspartame and should not be used by phenylketonurics [see Warnings and Precautions (5.6)].
Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older
DOSING REGIMEN
200 mg/5 mL or
oral suspension*
Otitis media†, sinusitis, lower respiratory tract infections, and more severe infections
45 mg/kg/day
Less severe infections
* Each strength of suspension of amoxicillin and clavulanate potassium is available as a chewable tablet for use by older children.
† Duration of therapy studied and recommended for acute otitis media is 10 days.
Patients Weighing 40 kg or More
Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations.
The 250 mg tablet of amoxicillin and clavulanate potassium should not be used until the child weighs at least 40 kg, due to the different amoxicillin to clavulanic acid ratios in the 250 mg tablet of amoxicillin and clavulanate potassium (250 mg/125 mg) versus the 250 mg chewable tablet of amoxicillin and clavulanate potassium (250 mg/62.5 mg).
Patients with impaired renal function do not generally require a reduction in dose unless the impairment is severe. Renal impairment patients with a glomerular filtration rate of <30 mL/min should not receive the 875-mg dose. Patients with a glomerular filtration rate of 10 to 30 mL/min should receive 500 mg or 250 mg every 12 hours, depending on the severity of the infection. Patients with a glomerular filtration rate less than 10 mL/min should receive 500 mg or 250 mg every 24 hours, depending on severity of the infection.
Hemodialysis patients should receive 500 mg or 250 mg every 24 hours, depending on severity of the infection. They should receive an additional dose both during and at the end of dialysis.
Prepare a suspension at time of dispensing as follows: Tap bottle until all the powder flows freely. Add approximately 2/3 of the total amount of water for reconstitution (see Table 2 below) and shake vigorously to suspend powder. Add remainder of the water and again shake vigorously.
Table 2: Amount of Water for Mixing Oral Suspension
Amount of
Water for
Reconstitution
Contents of Each
Teaspoonful (5 mL)
200 mg amoxicillin and 28.5 mg of clavulanic acid as the potassium salt
400 mg amoxicillin and 57 mg of clavulanic acid as the potassium salt
Note: Shake oral suspension well before using. Reconstituted suspension must be stored under refrigeration and discarded after 10 days.
Amoxicillin and Clavulanate Potassium Tablets, USP, 250 mg/125 mg: Each film coated tablet, for oral administration, is white, capsule shaped, debossed GGN5 on one side and plain on the reverse side, and contains 250 mg amoxicillin as the trihydrate and 125 mg clavulanic acid as the potassium salt.
Amoxicillin and Clavulanate Potassium Tablets, USP, 500 mg/125 mg: Each film coated tablet, for oral administration, is white, oval-shaped, debossed GGN6 on one side and plain on the reverse side, and contains 500 mg amoxicillin as the trihydrate and 125 mg clavulanic acid as the potassium salt.
Amoxicillin and Clavulanate Potassium Tablets, USP, 875 mg/125 mg: Each film coated tablet, for oral administration, is white, capsule-shaped, scored and debossed GGN7 on one side and scored on the reverse side, and contains 875 mg amoxicillin as the trihydrate and 125 mg clavulanic acid as the potassium salt.
For Oral Suspension
Amoxicillin and Clavulanate Potassium for Oral Suspension, USP, 200 mg/28.5 mg per 5 mL: as a dry, white powder. Each 5 mL of reconstituted orange-flavored suspension contains 200 mg amoxicillin as the trihydrate and 28.5 mg clavulanic acid as the potassium salt.
Amoxicillin and Clavulanate Potassium for Oral Suspension, USP, 400 mg/57 mg per 5 mL: as a dry, white powder. Each 5 mL of reconstituted orange-flavored suspension contains 400 mg amoxicillin as the trihydrate and 57 mg clavulanic acid as the potassium salt.
Amoxicillin and Clavulanate Potassium Tablets, USP, (Chewable) 200 mg/28.5 mg: Each chewable tablet is round, pink, cherry-banana flavored, embossed GGN2 on one side and plain on the reverse side, and contains 200 mg amoxicillin as the trihydrate and 28.5 mg clavulanic acid as the potassium salt.
Amoxicillin and Clavulanate Potassium Tablets, USP, (Chewable) 400 mg/57 mg: Each chewable tablet is round, pink, cherry-banana flavored, embossed GGN4 on one side and plain on the reverse side, and contains 400 mg amoxicillin as the trihydrate and 57 mg clavulanic acid as the potassium salt.
The 250 mg tablet of amoxicillin and clavulanate potassium and the 250 mg chewable tablet should NOT be substituted for each other, as they are not interchangeable and the 250 mg tablet should not be used in children weighing less than 40 kg. The 250 mg tablet of amoxicillin and clavulanate potassium and the 250 mg chewable tablet do not contain the same amount of clavulanic acid. The 250 mg tablet of amoxicillin and clavulanate potassium contains 125 mg of clavulanic acid whereas the 250 mg chewable tablet contains 62.5 mg of clavulanic acid.
Two 250 mg tablets of amoxicillin and clavulanate potassium should NOT be substituted for one 500 mg tablet of amoxicillin and clavulanate potassium. Since both the 250 mg and 500 mg tablets of amoxicillin and clavulanate potassium contain the same amount of clavulanic acid (125 mg, as the potassium salt), two 250 mg tablets of amoxicillin and clavulanate potassium are not equivalent to one 500 mg tablet of amoxicillin and clavulanate potassium.
Amoxicillin and clavulanate potassium is contraindicated in patients with a history of serious hypersensitivity reactions (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin, clavulanate or to other beta-lactam antibacterial drugs (e.g., penicillins and cephalosporins).
Amoxicillin and clavulanate potassium is contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with amoxicillin and clavulanate potassium.
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving beta-lactam antibacterials, including amoxicillin and clavulanate potassium. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens. Before initiating therapy with amoxicillin and clavulanate potassium, careful inquiry should be made regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. If an allergic reaction occurs, amoxicillin and clavulanate potassium should be discontinued and appropriate therapy instituted.
Hepatic dysfunction, including hepatitis and cholestatic jaundice has been associated with the use of amoxicillin and clavulanate potassium. Hepatic toxicity is usually reversible; however, deaths have been reported. Hepatic function should be monitored at regular intervals in patients with hepatic impairment.
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including amoxicillin and clavulanate potassium, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C.difficile.
C.difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin-producing strains of C.difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibacterial use not directed against C.difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C.difficile, and surgical evaluation should be instituted as clinically indicated.
A high percentage of patients with mononucleosis who receive amoxicillin develop an erythematous skin rash. Thus, amoxicillin and clavulanate potassium should not be administered to patients with mononucleosis.
The possibility of superinfections with fungal or bacterial pathogens should be considered during therapy. If superinfection occurs, amoxicillin/clavulanate potassium should be discontinued and appropriate therapy instituted.
Amoxicillin and clavulanate potassium chewable tablets and amoxicillin and clavulanate potassium for oral suspension contain aspartame which contains phenylalanine. Each 200 mg chewable tablet of amoxicillin and clavulanate potassium contains 2 mg phenylalanine; each 400 mg chewable tablet contains 4 mg phenylalanine; each 5 mL of either the 200 mg/5 mL or 400 mg/5 mL oral suspension contains 7 mg phenylalanine. The other formulations of amoxicillin and clavulanate potassium do not contain phenylalanine.
Prescribing amoxicillin and clavulanate potassium in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient, and increases the risk of the development of drug-resistant bacteria.
The following are discussed in more detail in other sections of the labeling:
Anaphylactic reactions [see Warnings and Precautions (5.1)]
Hepatic Dysfunction [see Warnings and Precautions (5.2)]
CDAD [see Warnings and Precautions (5.3)]
The most frequently reported adverse reactions were diarrhea/loose stools (9%), nausea (3%), skin rashes and urticaria (3%), vomiting (1%) and vaginitis (1%). Less than 3% of patients discontinued therapy because of drug-related adverse reactions. The overall incidence of adverse reactions, and in particular diarrhea, increased with the higher recommended dose. Other less frequently reported adverse reactions (<1%) include: Abdominal discomfort, flatulence, and headache.
In pediatric patients (aged 2 months to 12 years), 1 US/Canadian clinical trial was conducted which compared 45/6.4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media. A total of 575 patients were enrolled, and only the suspension formulations were used in this trial. Overall, the adverse reactions seen were comparable to that noted above; however, there were differences in the rates of diarrhea, skin rashes/urticaria, and diaper area rashes [see Clinical Studies (14.2)].
In addition to adverse reactions reported from clinical trials, the following have been identified during post-marketing use of amoxicillin and clavulanate potassium. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal connection to amoxicillin and clavulanate potassium.
Gastrointestinal: Indigestion, gastritis, stomatitis, glossitis, black "hairy" tongue, mucocutaneous candidiasis, enterocolitis, and hemorrhagic/pseudomembranous colitis. Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment [see Warnings and Precautions (5.3)].
Hypersensitivity Reactions: Pruritus, angioedema, serum sickness–like reactions (urticaria or skin rash accompanied by arthritis, arthralgia, myalgia, and frequently fever), erythema multiforme, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, hypersensitivity vasculitis, and cases of exfoliative dermatitis (including toxic epidermal necrolysis) have been reported [see Warnings and Precautions (5.1)].
Liver: Hepatic dysfunction, including hepatitis and cholestatic jaundice, increases in serum transaminases (AST and/or ALT), serum bilirubin, and/or alkaline phosphatase, has been reported with amoxicillin and clavulanate potassium. It has been reported more commonly in the elderly, in males, or in patients on prolonged treatment. The histologic findings on liver biopsy have consisted of predominantly cholestatic, hepatocellular, or mixed cholestatic-hepatocellular changes. The onset of signs/symptoms of hepatic dysfunction may occur during or several weeks after therapy has been discontinued. The hepatic dysfunction, which may be severe, is usually reversible. Deaths have been reported [see Contraindications (4.2), Warnings and Precautions (5.2)].
Renal: Interstitial nephritis, hematuria, and crystalluria have been reported [see Overdosage (10)].
Hemic and Lymphatic Systems: Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Thrombocytosis was noted in less than 1% of the patients treated with amoxicillin and clavulanate potassium. There have been reports of increased prothrombin time in patients receiving amoxicillin and clavulanate potassium and anticoagulant therapy concomitantly [see Drug Interactions (7.2)].
Central Nervous System: Agitation, anxiety, behavioral changes, confusion, convulsions, dizziness, insomnia, and reversible hyperactivity have been reported.
Miscellaneous: Tooth discoloration (brown, yellow, or gray staining) has been reported. Most reports occurred in pediatric patients. Discoloration was reduced or eliminated with brushing or dental cleaning in most cases.
Probenecid decreases the renal tubular secretion of amoxicillin but does not delay renal excretion of clavulanic acid. Concurrent use with amoxicillin and clavulanate potassium may result in increased and prolonged blood concentrations of amoxicillin. Co-administration of probenecid is not recommended.
Abnormal prolongation of prothrombin time (increased international normalized ratio [INR]) has been reported in patients receiving amoxicillin and oral anticoagulants. Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently with amoxicillin and clavulanate potassium. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation.
The concurrent administration of allopurinol and amoxicillin increases the incidence of rashes in patients receiving both drugs as compared to patients receiving amoxicillin alone. It is not known whether this potentiation of amoxicillin rashes is due to allopurinol or the hyperuricemia present in these patients.
Amoxicillin and clavulanate potassium may affect intestinal flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives.
High urine concentrations of amoxicillin may result in false-positive reactions when testing for the presence of glucose in urine using CLINITEST®, Benedict's Solution, or Fehling's Solution. Since this effect may also occur with amoxicillin and clavulanate potassium, it is recommended that glucose tests based on enzymatic glucose oxidase reactions be used.
Following administration of amoxicillin to pregnant women, a transient decrease in plasma concentration of total conjugated estriol, estriol-glucuronide, conjugated estrone, and estradiol has been noted.
Teratogenic Effects
Reproduction studies performed in pregnant rats and mice given amoxicillin and clavulanate potassium (2:1 ratio formulation of amoxicillin:clavulanate) at oral doses up to 1200 mg/kg/day revealed no evidence of harm to the fetus due to amoxicillin and clavulanate potassium. The amoxicillin doses in rats and mice (based on body surface area) were approximately 4 and 2 times the maximum recommended adult human oral dose (875 mg every 12 hours). For clavulanate, these dose multiples were approximately 9 and 4 times the maximum recommended adult human oral dose (125 mg every 8 hours). There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Oral ampicillin-class antibiotics are poorly absorbed during labor. It is not known whether use of amoxicillin/clavulanate potassium in humans during labor or delivery has immediate or delayed adverse effects on the fetus, prolongs the duration of labor, or increases the likelihood of the necessity for an obstetrical intervention.
Amoxicillin has been shown to be excreted in human milk. Amoxicillin/clavulanate potassium use by nursing mothers may lead to sensitization of infants. Caution should be exercised when amoxicillin/clavulanate potassium is administered to a nursing woman.
The safety and effectiveness of amoxicillin and clavulanate potassium for oral suspension and chewable tablets have been established in pediatric patients. Use of amoxicillin and clavulanate potassium in pediatric patients is supported by evidence from studies of amoxicillin and clavulanate potassium tablets in adults with additional data from a study of amoxicillin and clavulanate potassium for oral suspension in pediatric patients aged 2 months to 12 years with acute otitis media [see Clinical Studies (14.2)].
Because of incompletely developed renal function in neonates and young infants, the elimination of amoxicillin may be delayed; clavulanate elimination is unaltered in this age group. Dosing of amoxicillin and clavulanate potassium should be modified in pediatric patients aged <12 weeks (<3 months) [see Dosage and Administration (2.2)].
Of the 3,119 patients in an analysis of clinical studies of amoxicillin and clavulanate potassium, 32% were ≥65 years old, and 14% were ≥75 years old. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Amoxicillin is primarily eliminated by the kidney and dosage adjustment is usually required in patients with severe renal impairment (GFR <30 mL/min). See Patients with Renal Impairment (2.3) for specific recommendations in patients with renal impairment.
In case of overdosage, discontinue medication, treat symptomatically, and institute supportive measures as required. A prospective study of 51 pediatric patients at a poison-control center suggested that overdosages of less than 250 mg/kg of amoxicillin are not associated with significant clinical symptoms1.
Interstitial nephritis resulting in oliguric renal failure has been reported in patients after overdosage with amoxicillin/clavulanate potassium.
Crystalluria, in some cases leading to renal failure, has also been reported after amoxicillin/clavulanate potassium overdosage in adult and pediatric patients. In case of overdosage, adequate fluid intake and diuresis should be maintained to reduce the risk of amoxicillin/clavulanate potassium crystalluria.
Renal impairment appears to be reversible with cessation of drug administration. High blood levels may occur more readily in patients with impaired renal function because of decreased renal clearance of amoxicillin/clavulanate potassium. Amoxicillin/clavulanate potassium may be removed from circulation by hemodialysis [see Dosage and Administration (2.3)].
Amoxicillin and clavulanate potassium tablets, USP; for oral suspension, USP; and chewable tablets, USP are oral antibacterial combinations consisting of amoxicillin and the beta-lactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid). Amoxicillin is an analog of ampicillin, derived from the basic penicillin nucleus, 6-aminopenicillanic acid. The amoxicillin molecular formula is C16H19N3O5S•3H2O, and the molecular weight is 419.46. Chemically, amoxicillin is (2S,5R,6R)-6-[(R)-(-)-2-Amino-2-(phydroxyphenyl)acetamido]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid trihydrate and may be represented structurally as:
Clavulanic acid is produced by the fermentation of Streptomyces clavuligerus. It is a beta-lactam structurally related to the penicillins and possesses the ability to inactivate some beta-lactamases by blocking the active sites of these enzymes. The clavulanate potassium molecular formula is C8H8KNO5, and the molecular weight is 237.25. Chemically, clavulanate potassium is potassium (Z)(2R,5R)-3-(2-hydroxyethylidene)-7-oxo-4-oxa-1-azabicyclo[3.2.0]-heptane-2-carboxylate and may be represented structurally as:
Tablets – Colloidal silicon dioxide, hypromellose, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, talc, titanium dioxide, triethyl citrate, ethylcellulose, cetyl alcohol and sodium lauryl sulfate. In addition, the 875 mg/125 mg tablet contains crospovidone. Each tablet of amoxicillin and clavulanate potassium contains 0.63 mEq potassium.
For Oral Suspension – Aspartame, colloidal silicon dioxide, hydroxypropyl methylcellulose, mannitol, orange flavoring, precipitated silicon dioxide, succinic acid, xanthan gum, and golden syrup flavoring (caramel).
Chewable Tablets – Aspartame, banana flavoring, cherry flavoring, colloidal silicon dioxide, FD&C Red No. 40, magnesium stearate, mannitol, and sodium starch glycolate [see Warnings and Precautions (5.6)].
∘
Each 200 mg chewable tablet and each 5 mL of reconstituted 200 mg/5 mL oral suspension of amoxicillin and clavulanate potassium contains 0.14 mEq potassium
Amoxicillin and clavulanate potassium is an antibacterial drug [see Microbiology 12.4].
Mean amoxicillin and clavulanate potassium pharmacokinetic parameters in normal adults following administration of amoxicillin and clavulanate potassium tablets are shown in Table 3 and following administration of amoxicillin and clavulanate potassium for oral suspension and chewable tablets are shown in Table 4.
Table 3: Mean (±S.D.) Amoxicillin and Clavulanate Potassium Pharmacokinetic Parameters*, † with Amoxicillin and Clavulanate Potassium Tablets
Dose and Regimen
Cmax (mcg/mL)
AUC0-24 (mcg•h/mL)
Amoxicillin/Clavulanate
Clavulanate
250 mg/125 mg
3.3 ± 1.12
26.7 ± 4.56
53.5 ± 12.31
* Mean (± standard deviation) values of 14 normal adults (N=15 for clavulanate potassium in the low-dose regimens). Peak concentrations occurred approximately 1.5 hours after the dose.
† Amoxicillin/clavulanate potassium administered at the start of a light meal.
Table 4: Mean (±S.D.) Amoxicillin and Clavulanate Potassium Pharmacokinetic Parameters*, † with Amoxicillin and Clavulanate Potassium for Oral Suspension and Chewable Tablets
(5 mL of
suspension)
6.94 ± 1.24
17.29 ± 2.28
(1 chewable
tablet)
* Mean (± standard deviation) values of 28 normal adults. Peak concentrations occurred approximately 1 hour after the dose.
Oral administration of 5 mL of 250 mg/5 mL suspension of amoxicillin and clavulanate potassium or the equivalent dose of 10 mL of 125 mg/5 mL suspension of amoxicillin and clavulanate potassium provides average peak serum concentrations approximately 1 hour after dosing of 6.9 mcg/mL for amoxicillin and 1.6 mcg/mL for clavulanic acid. The areas under the serum concentration curves obtained during the first 4 hours after dosing were 12.6 mcg•h/mL for amoxicillin and 2.9 mcg•h/mL for clavulanic acid when 5 mL of 250 mg/5 mL suspension of amoxicillin and clavulanate potassium or equivalent dose of 10 mL of 125 mg/5 mL suspension of amoxicillin and clavulanate potassium were administered to normal adults. One 250 mg chewable tablet of amoxicillin and clavulanate potassium or two 125 mg chewable tablets of amoxicillin and clavulanate potassium are equivalent to 5 mL of 250 mg/5 mL suspension of amoxicillin and clavulanate potassium and provide similar serum concentrations of amoxicillin and clavulanic acid.
Amoxicillin serum concentrations achieved with amoxicillin and clavulanate potassium are similar to those produced by the oral administration of equivalent doses of amoxicillin alone. Time above the minimum inhibitory concentration of 1 mcg/mL for amoxicillin has been shown to be similar after corresponding every 12 hour and every 8 hour dosing regimens of amoxicillin and clavulanate potassium in adults and children.
Dosing in the fasted or fed state has minimal effect on the pharmacokinetics of amoxicillin. While amoxicillin and clavulanate potassium can be given without regard to meals, absorption of clavulanate potassium when taken with food is greater relative to the fasted state. In one study, the relative bioavailability of clavulanate was reduced when amoxicillin and clavulanate potassium was dosed at 30 and 150 minutes after the start of a high-fat breakfast.
Neither component in amoxicillin and clavulanate potassium is highly protein-bound; clavulanic acid is approximately 25% bound to human serum and amoxicillin approximately 18% bound.
Amoxicillin diffuses readily into most body tissues and fluids with the exception of the brain and spinal fluid.
Two hours after oral administration of a single 35 mg/kg dose of suspension of amoxicillin and clavulanate potassium to fasting children, average concentrations of 3 mcg/mL of amoxicillin and 0.5 mcg/mL of clavulanic acid were detected in middle ear effusions.
Metabolism and Excretion
The half-life of amoxicillin after the oral administration of amoxicillin and clavulanate potassium is 1.3 hours and that of clavulanic acid is 1 hour.
Approximately 50% to 70% of the amoxicillin and approximately 25% to 40% of the clavulanic acid are excreted unchanged in urine during the first 6 hours after administration of a single 250 mg or 500 mg tablet of amoxicillin and clavulanate potassium.
Amoxicillin is a semisynthetic antibiotic with in vitro bactericidal activity against Gram-positive and Gram-negative bacteria. Amoxicillin is, however, susceptible to degradation by beta-lactamases, and therefore, the spectrum of activity does not include organisms which produce these enzymes. Clavulanic acid is a beta-lactam, structurally related to the penicillins, which possesses the ability to inactivate some beta-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. In particular, it has good activity against the clinically important plasmid-mediated beta-lactamases frequently responsible for transferred drug resistance.
The formulation of amoxicillin and clavulanic acid in amoxicillin and clavulanate potassium protects amoxicillin from degradation by some beta-lactamase enzymes and extends the antibiotic spectrum of amoxicillin to include many bacteria normally resistant to amoxicillin.
Amoxicillin/clavulanic acid has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section.
Enterobacter species
Klebsiella species
The following in vitro data are available, but their clinical significance is unknown. At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for amoxicillin/clavulanic acid. However, the efficacy of amoxicillin/clavulanic acid in treating clinical infections due to these bacteria has not been established in adequate and well-controlled clinical trials.
Staphylococcus epidermidis
Viridans group Streptococcus
Eikenella corrodens
Bacteroides species including Bacteroides fragilis
Fusobacterium species
Peptostreptococcus species
Long-term studies in animals have not been performed to evaluate carcinogenic potential. Amoxicillin and clavulanate potassium (4:1 ratio formulation of amoxicillin:clavulanate) was non-mutagenic in the Ames bacterial mutation assay, and the yeast gene conversion assay. Amoxicillin and clavulanate potassium was weakly positive in the mouse lymphoma assay, but the trend toward increased mutation frequencies in this assay occurred at doses that were also associated with decreased cell survival. Amoxicillin and clavulanate potassium was negative in the mouse micronucleus test, and in the dominant lethal assay in mice. Potassium clavulanate alone was tested in the Ames bacterial mutation assay and in the mouse micronucleus test, and was negative in each of these assays.
Amoxicillin and clavulanate potassium (2:1 ratio formulation of amoxicillin:clavulanate) at oral doses of up to 1,200 mg/kg/day was found to have no effect on fertility and reproductive performance in rats. Based on body surface area, this dose of amoxicillin is approximately 4 times the maximum recommended adult human oral dose (875 mg every 12 hours). For clavulanate, the dose multiple is approximately 9 times higher than the maximum recommended adult human oral dose (125 mg every 8 hours), also based on body surface area.
Data from 2 pivotal trials in 1,191 patients treated for either lower respiratory tract infections or complicated urinary tract infections compared a regimen of 875 mg tablets of amoxicillin and clavulanate potassium every 12 hours to 500 mg tablets of amoxicillin and clavulanate potassium dosed every 8 hours (584 and 607 patients, respectively). Comparable efficacy was demonstrated between the every 12 hours and every 8 hours dosing regimens. There was no significant difference in the percentage of adverse events in each group. The most frequently reported adverse event was diarrhea; incidence rates were similar for the 875 mg every 12 hours and 500 mg every 8 hours dosing regimens (15% and 14%, respectively); however, there was a statistically significant difference (p < 0.05) in rates of severe diarrhea or withdrawals with diarrhea between the regimens: 1% for 875 mg every 12 hours regimen versus 2% for the 500 mg every 8 hours regimen.
In one of these pivotal trials, patients with either pyelonephritis (n = 361) or a complicated urinary tract infection (i.e., patients with abnormalities of the urinary tract that predispose to relapse of bacteriuria following eradication, n = 268) were randomized (1:1) to receive either 875 mg tablets of amoxicillin and clavulanate potassium every 12 hours (n=308) or 500 mg tablets of amoxicillin and clavulanate potassium every 8 hours (n=321).
The number of bacteriologically evaluable patients was comparable between the two dosing regimens. Amoxicillin and clavulanate potassium produced comparable bacteriological success rates in patients assessed 2 to 4 days immediately following end of therapy. The bacteriologic efficacy rates were comparable at one of the follow-up visits (5 to 9 days post-therapy) and at a late post-therapy visit (in the majority of cases, this was 2 to 4 weeks post-therapy), as seen in Table 5.
Table 5: Bacteriologic efficacy rates for amoxicillin and clavulanate potassium
Time Post Therapy
875 mg every
12 hours % (n)
8 hours % (n)
As noted before, though there was no significant difference in the percentage of adverse events in each group, there was a statistically significant difference in rates of severe diarrhea or withdrawals with diarrhea between the regimens.
One US/Canadian clinical trial was conducted which compared 45/6.4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media. Only the suspension formulations were used in this trial. A total of 575 pediatric patients (aged 2 months to 12 years) were enrolled, with an even distribution among the 2 treatment groups and a comparable number of patients were evaluable (i.e., ≥ 84%) per treatment group. Otitis media-specific criteria were required for eligibility and a strong correlation was found at the end of therapy and follow-up between these criteria and physician assessment of clinical response. The clinical efficacy rates at the end of therapy visit (defined as 2 to 4 days after the completion of therapy) and at the follow-up visit (defined as 22 to 28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively. At follow-up, 67% (n = 249) and 69% (n = 243) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.
Diarrhea was defined as either: (a) 3 or more watery or 4 or more loose/watery stools in 1 day; OR (b) 2 watery stools per day or 3 loose/watery stools per day for 2 consecutive days. The incidence of diarrhea was significantly lower in patients who received the every 12 hours regimen compared to patients who received the every 8 hours regimen (14% and 34%, respectively). In addition, the number of patients with either severe diarrhea or who were withdrawn with diarrhea was significantly lower in the every 12 hours treatment group (3% and 8% for the every 12 hours/10 day and every 8 hours/10 day, respectively). In the every 12 hours treatment group, 3 patients (1%) were withdrawn with an allergic reaction, while 1 patient in the every 8 hours group was withdrawn for this reason. The number of patients with a candidal infection of the diaper area was 4% and 6% for the every 12 hours and every 8 hours groups, respectively.
It is not known if the finding of a statistically significant reduction in diarrhea with the oral suspensions dosed every 12 hours, versus suspensions dosed every 8 hours, can be extrapolated to the chewable tablets. The presence of mannitol in the chewable tablets may contribute to a different diarrhea profile. The every 12 hour oral suspensions (200 mg/5 mL and 400 mg/5 mL) are sweetened with aspartame.
Swanson-Biearman B, Dean BS, Lopez G, Krenzelok EP. The effects of penicillin and cephalosporin ingestions in children less than six years of age. Vet Hum Toxicol. 1988; 30: 66-67.
NDC 0781-1874-31 bottles of 30
NDC 0781-1831-13 Unit Dose (10 x 10) 100 film coated tablets
NDC 0781-1852-13 Unit Dose (4 x 25) 100 film coated tablets
Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Dispense in original container; advise patient to keep in closed container.
Amoxicillin and Clavulanate Potassium for Oral Suspension, USP 200 mg/28.5 mg per 5 mL: as a dry, white powder. Each 5 mL of reconstituted orange-flavored suspension contains 200 mg amoxicillin as the trihydrate and 28.5 mg clavulanic acid as the potassium salt.
NDC 0781-6102-46 100 mL bottle
Amoxicillin and Clavulanate Potassium for Oral Suspension, USP 400 mg/57 mg per 5 mL: as a dry, white powder. Each 5 mL of reconstituted orange-flavored suspension contains 400 mg amoxicillin as the trihydrate and 57 mg clavulanic acid as the potassium salt.
Store dry powder at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Dispense in original container; Store reconstituted suspension under refrigeration. Discard unused suspension after 10 days.
Amoxicillin and Clavulanate Potassium 200 mg/28.5 mg tablets, USP (chewable): Each chewable tablet is round, pink, cherry-banana flavored, embossed GGN2 on one side and plain on the reverse side, and contains 200 mg amoxicillin as the trihydrate and 28.5 mg clavulanic acid as the potassium salt.
NDC 0781-1619-66 Carton of 20 (4 x 5) tablets
Amoxicillin and Clavulanate Potassium 400 mg/57 mg tablets, USP (chewable): Each chewable tablet is round, pink, cherry-banana flavored, embossed GGN4 on one side and plain on the reverse side, and contains 400 mg amoxicillin as the trihydrate and 57 mg clavulanic acid as the potassium salt.
Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Dispense in original container.
Patients should be informed that amoxicillin and clavulanate potassium may be taken every 8 hours or every 12 hours, depending on the dose prescribed. Each dose should be taken with a meal or snack to reduce the possibility of gastrointestinal upset.
Patients should be counseled that antibacterial drugs, including amoxicillin and clavulanate potassium, should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When amoxicillin and clavulanate potassium is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin and clavulanate potassium or other antibacterial drugs in the future.
Counsel patients that diarrhea is a common problem caused by antibacterials, and it usually ends when the antibacterial is discontinued. Sometimes after starting treatment with antibacterials, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as 2 or more months after having taken their last dose of the antibacterial. If diarrhea is severe or lasts more than 2 or 3 days, patients should contact their physician.
Patients should be advised to keep suspension refrigerated. Shake well before using. When dosing a child with the suspension (liquid) of amoxicillin and clavulanate potassium, use a dosing spoon or medicine dropper. Be sure to rinse the spoon or dropper after each use. Bottles of suspension of amoxicillin and clavulanate potassium may contain more liquid than required. Follow your doctor's instructions about the amount to use and the days of treatment your child requires. Discard any unused medicine.
Patients should be aware that amoxicillin and clavulanate potassium contains a penicillin class drug product that can cause allergic reactions in some individuals.
CLINITEST® is a registered trademark of Miles, Inc.
Manufactured by Sandoz GmbH for Sandoz Inc., Princeton, NJ 08540
Tablets 250 mg/125 mg Label
And Clavulanate
Tablets, USP
250 mg/125 mg*
Oral Suspension 200 mg/28.5 mg Label
Amoxicillin and
Potassium for Oral
Suspension, USP
200 mg/28.5 mg (per 5 mL)
When reconstituted,
each 5 mL contains:
AMOXICILLIN, 200 mg,
as the trihydrate
CLAVULANIC ACID, 28.5 mg,
as clavulanate potassium
Oral Suspension 400 mg/57 mg Label
400 mg/57 mg (per 5 mL)
CLAVULANIC ACID, 57 mg,
Chewable Tablets 200 mg/28.5 mg Carton
Potassium Tablets, USP
(Chewable)
200 mg/28.5 mg*
Chewable Tablets 400 mg/57 mg Carton
400 mg/57 mg*
amoxicillin and clavulanate potassium tablet, film coated
AMOXICILLIN (UNII: 804826J2HU) (AMOXICILLIN ANHYDROUS - UNII:9EM05410Q9) AMOXICILLIN ANHYDROUS 250 mg
CLAVULANATE POTASSIUM (UNII: Q42OMW3AT8) (CLAVULANIC ACID - UNII:23521W1S24) CLAVULANIC ACID 125 mg
CETYL ALCOHOL (UNII: 936JST6JCN)
ETHYLCELLULOSE, UNSPECIFIED (UNII: 7Z8S9VYZ4B)
HYPROMELLOSE, UNSPECIFIED (UNII: 3NXW29V3WO)
SODIUM STARCH GLYCOLATE TYPE A POTATO (UNII: 5856J3G2A2)
TRIETHYL CITRATE (UNII: 8Z96QXD6UM)
Shape OVAL (capsule-shaped) Size 18mm
Flavor Imprint Code GGN5
NDC:0781-1874-31 30 in 1 BOTTLE; Type 0: Not a Combination Product 08/23/2005
Shape OVAL Size 21mm
NDC:0781-1831-13 100 in 1 BOX, UNIT-DOSE; Type 0: Not a Combination Product 03/15/2002
CROSPOVIDONE (15 MPA.S AT 5%) (UNII: 68401960MK)
Color WHITE Score 2 pieces
AMOXICILLIN (UNII: 804826J2HU) (AMOXICILLIN ANHYDROUS - UNII:9EM05410Q9) AMOXICILLIN ANHYDROUS 200 mg in 5 mL
CLAVULANATE POTASSIUM (UNII: Q42OMW3AT8) (CLAVULANIC ACID - UNII:23521W1S24) CLAVULANIC ACID 28.5 mg in 5 mL
ORANGE (UNII: 5EVU04N5QU)
SUCCINIC ACID (UNII: AB6MNQ6J6L)
NDC:0781-6102-46 100 mL in 1 BOTTLE; Type 0: Not a Combination Product 06/05/2002
CLAVULANATE POTASSIUM (UNII: Q42OMW3AT8) (CLAVULANIC ACID - UNII:23521W1S24) CLAVULANIC ACID 57 mg in 5 mL
CLAVULANATE POTASSIUM (UNII: Q42OMW3AT8) (CLAVULANIC ACID - UNII:23521W1S24) CLAVULANIC ACID 28.5 mg
BANANA (UNII: 4AJZ4765R9)
CHERRY (UNII: BUC5I9595W)
Color PINK Score no score
NDC:0781-1619-66 5 in 1 CARTON 04/18/2002 07/20/2016
ANDA ANDA065065 04/18/2002 07/20/2016
CLAVULANATE POTASSIUM (UNII: Q42OMW3AT8) (CLAVULANIC ACID - UNII:23521W1S24) CLAVULANIC ACID 57 mg
Labeler - Sandoz Inc (005387188)
1 562251 amoxicillin 250 MG / clavulanate potassium 125 MG Oral Tablet PSN
2 562251 amoxicillin 250 MG / clavulanate 125 MG Oral Tablet SCD
3 562251 amoxicillin (as amoxicillin trihydrate) 250 MG / clavulanic acid (as clavulanate potassium) 125 MG Oral Tablet SY
10 617309 amoxicillin 200 MG / clavulanate potassium 28.5 MG Chewable Tablet PSN
11 617309 amoxicillin 200 MG / clavulanate 28.5 MG Chewable Tablet SCD
12 617309 amoxicillin 200 MG / clavulanate (as clavulanate potassium) 28.5 MG Chewable Tablet SY
13 617316 amoxicillin 400 MG / clavulanate potassium 57 MG Chewable Tablet PSN
14 617316 amoxicillin 400 MG / clavulanate 57 MG Chewable Tablet SCD
15 617316 amoxicillin 400 MG / clavulanate (as clavulanate potassium) 57 MG Chewable Tablet SY
16 617423 amoxicillin 200 MG / clavulanic acid 28.5 MG in 5 mL Oral Suspension PSN
17 617423 amoxicillin 40 MG/ML / clavulanate 5.7 MG/ML Oral Suspension SCD
18 617423 amoxicillin 200 MG / clavulanic acid 28.5 MG per 5 ML Oral Suspension SY
19 617423 amoxicillin (as amoxicillin trihydrate) 200 MG / clavulanic acid (as clavulanate potassium) 28.5 MG per 5 ML Oral Suspension SY
20 617430 amoxicillin 400 MG / clavulanic acid 57 MG in 5 mL Oral Suspension PSN
21 617430 amoxicillin 80 MG/ML / clavulanate 11.4 MG/ML Oral Suspension SCD
22 617430 amoxicillin 400 MG / clavulanic acid 57 MG per 5 ML Oral Suspension SY
23 617430 amoxicillin (as amoxicillin trihydrate) 400 MG / clavulanic acid (as clavulanate potassium) 57 MG per 5 ML Oral Suspension SY
https://dailymed.nlm.nih.gov/dailymed/labelrss.cfm?setid=7cba82f0-9886-46e9-8dbd-43a448aade29
1 0781-1619-66

redpajama_set_name: RedPajamaCommonCrawl


This week's Torah portion is framed by death. It opens with the passing of Sarah, mother of our people and ends with the death of her husband Abraham. After Sarah dies, the first thing Abraham does is "mourn and cry" – לִסְפֹּ֥ד לְשָׂרָ֖ה וְלִבְכֹּתָֽהּ. As we reflect on the slaughter of the "righteous eleven" last Shabbat at that is the first thing due them. In the Torah the letter כ׳ in the word וְלִבְכֹּתָֽהּ "to cry" is smaller than the others. That is what it means to grieve, to be diminished by the loss of a loved one. And that is us this Shabbat as we remember those killed at Congregation Etz Chaim, for "all Israel is connected one to the other".
We mourn, however, not only the death of Joyce Fienburg, Richard Gottfried, Rose Mallinger, Jerry Rabinowitz, Cecil Rosenthal, David Rosenthal, Bernice Simon, Sylvan Simon, Daniel Stein, Melvin Wax and Irving Younger. We also cry for the passing of our innocence about our place as Jews in this country. We mourn for an America where mass shootings have become the norm, a land that has become numb to the slaughter of innocents in prayer and the young in their schools. We bewail a politics that excuses those who besmirch what is true and denigrate the dignity of others.
Actually, we should not be surprised that a synagogue was attacked. Gun violence is an epidemic in our land. We teach 2 and 3-year old's to hide in closets, disguising active shooter training as a game. Our students go into their schools to learn what to do should some fellow student turn cafeteria into a slaughterhouse. Hundreds are injured and killed at a concert. At Sandy Hook, Connecticut Kindergarten students and their teachers are butchered. In a Charleston, South Carolina, Black church parishioners studying the Bible are gunned down. There is mass shooting after mass shooting. And we do nothing. Our leaders talk and talk – and the dead pile up in heaps. How can we speak of our greatness as a nation when we allow this to continue? We are morally bankrupt.
After the Shoah (the Holocaust) we rose up as Jews and committed ourselves to a new commandment – a 614th mitzvah – "never again." Living in America as Jews – safe, secure, confident – we promised not to stand idly by as hate grew. "Never again" we pledged – determined to not allow hate or racism or anti-Semitism to go unanswered. And yet … and yet. In the past two years the number of anti-Semitic incidents has surged in this country. Anti-Jewish extremism is on the rise. Alongside that is the growing accessibility of the most lethal of weapons. Add to that the anti-immigrant rhetoric that we hear from so many (including our President). It is a dangerous, fatal mix. So – we should be surprised that Jews were targeted, Jews killed specifically because they affirm our Torah's values of welcoming refugees?! We should be shocked that it a synagogue that was attacked?! The real shock should be that it took so long.
The effort to intimidate the Jews of Germany on Kristallnacht in November 1938 did not appear out of nowhere. It was the result of years of a nation turning aside its morality, excusing the rantings of a leader who brought Germany prosperity and a renewed sense of self-worth. Germans felt good about themselves again. And if the price was roughing up some Jews – or, better yet, getting rid of them, so what? Kristallnacht stands as a warning – small acts of hate, unanswered lies and blame of the "other" left unanswered lead inexorably to new and dark reality, the legalization of exclusion and inevitably to an acceptance of violence.
Unlike on Kristallnacht, when police and firefighters let the rampaging stormtroopers do their dirty work, Pittsburgh's finest came to the defense of our fellow Jews – four of those police officers wounded in the onslaught.
The Pittsburgh Post-Gazette has, on its website and under the logo on the front page, the Hebrew and Aramaic opening of the Mourners' Kaddish: יִתְגַּדַּל וְיִתְקַדַּשׁ שְׁמֵהּ רַבָּא, a communal acknowledgment that our Jewish pain is our national pain.
Tarek El-Messidi, a Chicago-based activist, started up a GoFundMe page for Muslims to give funds to help the victims and their families. In a few days over $225,000 was raised for the families of those murdered.
In Washington, DC last Sunday all federal buildings had their flags at half-staff, an official recognition of shared grief; and the President came to Pittsburgh to offer his personal respects. Whether you agreed with him doing so or not (I did, if you are wondering), these both stand in stark contrast to anything we Jews received from governments of the past.
At a hockey game between the NY Islanders and Pittsburgh Penguins, each players' helmet and jersey had their team logo emblazoned atop a Magen David (the Jewish star) with the words "Stronger than hate." Consider that as you recall Jews who, in living memory, were forced to wear that star as a symbol of humiliation and degradation.
So, no, America in 2018 is not Germany of 1938. But … we may be the Germany of 1932. We stand at the precipice. Wealthy and employed, we have grown fat and complacent to where hate can lead. Tighter security – more guards, higher walls, more impenetrable barriers – these are false hopes if our land is not cured of its sickness of hate and acceptance of violence.
Our prophets of old warned us. Woe to a people inured to violence. Woe to a land whose ruler turns truth to lies and affirms lies as true. Woe to a people whose accept elders and leaders who pervert justice for the sake of power. Woe to those who attack as invaders those who simply seek the liberty our own ancestors sought, and we expect. Woe to a land that sacrifices its own children, who put self-interest or the "rights" of some above the security of all.
For the Jews of Berlin in November 1938 it was too late. But in 1932 Germany might have taken a different path. On this night of remembrance, then, this must be our pledge to those who suffered on Kristallnacht and after. Truly, never again.
If ever there was a time to speak up, to defend our selves as Jews, to speak on behalf of others and be politically involved – it is now. Our State representatives, those who serve on our behalf in Congress, the President of our land – they work for me. They answer to you. I will not be quiet. I will not stand down. Nor should you. Let us vote as we must, lobby as we can, protest if need be. But let us act, so we not look back with regret for having not done more sooner.
Never again will we allow those who hate stifle our demands for truth, peace and compassion. Never again can we let go unanswered some snide remark or joke or put down of Blacks or women or Muslims or Latinos. Never again will we fail to defend our fellow Jews, for we are Am Echad, one people. Never again will we excuse calls of violence as mere political pandering.
Last Shabbat the Jews of Congregation Etz Chaim would have read in Torah Jews the section in Torah all Jews around the world read – how Avraham Avinu, stood in the heat of the day offered hospitality to strangers. They would have read – as did we – how Abraham spoke up for the innocent and righteous. "Should not the Judge of the Universe be just?" he challenged God – asking that Sodom and Gomorrah not be destroyed if there were but ten good people there. The prophet Isaiah speaks of the people of Israel as the "seed of Abraham, My (i.e. God's) lover." (Isaiah 41:8) That is who we are, the "seed of Abraham" – open to the stranger, defender of the needy, guardians of the truth.
But I sing nonetheless with love on our side.


text:
MusicRockSouthern California Music
Pi Jacobs Performs at Lestat's in San Diego
Maria Plascencia June 7, 2013
Pi Jacobs has come a long way since her first time singing on stage, when she was only three.
The San Francisco native has been a part of the music world for a long time, starting as a choir member when she was only three, to playing various instruments in high school.
After a break from being a singer, Pi worked on her first album, which included songs that ended up in some of MTV's famous shows, like the Real World. Even if you didn't know who Pi Jacobs is , you probably have heard her on various television shows, including Pretty Little Liars, Road Rules, and other shows from famous networks.
However, Pi enjoys playing in live shows too."To be a true artists, I have to go and play those songs for people," she explains.
Her fifth and most recent album, Urbanicana, was written by Pi herself, who believes the writing process to be a very personal experience. "It's really, really personal for me, I actually find collaboration really hard."
Although she finds writing with other people difficult, she does enjoy singing in harmony. "Of all the elements of music, if I could only have one, it would be people singing together," she explains. Her show at Lestat's in San Diego featured beautiful harmony along with two members of the Silverlake Chorus, which Pi was previously a member of. She described her show as a strip down, and it was. Pi Jacobs played guitar beautifully and brought the personal touch her lyrics have to the stage. She is a raw, talented singer that can transmit her audience to a place of realness and emotion, a place where the audience can feel.
Keep your eye on Pi, who is not only doing live shows in the United States, but is looking to go back to the UK soon, and hopefully hit Europe in the near future. Meanwhile, keep your ears open when you watch television shows, but make sure you catch her live when you can, it's quite a harmonious experience.
Her latest album, Urbanicana is set to be released this fall.
Pi Jacobs – Anything:
Pi Jacobs Pretty Little Liars Road Rules Silverlake Chorus Urbanicana
Maria Plascencia
Maria Jose grew up in Chula Vista. She moved to LA to attend USC and study Broadcast Journalism, along with American Studies and Ethnicity. Maria has enjoyed writing since a young age, but recently discovered her love for broadcast journalism. She is also a dancer, literature junkie, and music obsessed.
Webisode: Interview with Fredo Ortiz
Watch Man of Steel Red Carpet Premiere Live at 3PM PT/6PM ET
ROSALIA IS CURRENTLY YOUTUBES MOST VIEWED FEMALE ARTIST OF THE YEAR


Pizzeria Valdiano recipes are authentic original hand-made creations that have been developed and perfected over the past 30 years. With more than 30 specialty pies, pizza by the slice, stromboli, subs, salads, pastries, espresso and more, Pizzeria Valdiano's family knowledge of the industry and its "secrets" provide the original taste of Italy in America. They use only the freshest ingredients to prepare each recipe to perfection. Pizzeria Valdiano is owned and operated by the same family that brought Central Florida Michael's, Peppino's, and Papa Tony's - the Liguori Family.


Want to make a splash with your online video? Then you belong on YouTube. There really is no other choice.
Look at the most recent stats. YouTube/Google served up 42% of all videos viewed in July, while no other site cracked 4%, according to comScore. YouTube is the undisputed leader in online video – by more than 10x. Sure, people watch video on a wide variety of sites, but in July more than three quarters of them did it at YouTube. That's true reach. And since the typical viewer watched more than eight hours of online video in July, that translates into audiences bigger than the Superbowl, every month, on the Internet.
Just as Willie Sutton robbed banks "because that's where the money is," if you want viewership, go to where the viewers are: YouTube.
Sure, it's mostly a conglomeration of personal, tasteless and tacky videos. But YouTube also streams a wide variety of professionally produced shows and clips, from the biggest media companies all the way down to tiny producers with outsized dreams.
Sure, there's a lot of competition. Heck, nine billion videos were viewed on YouTube in July, and millions of new videos are uploaded every month.
That's not to say you can't find success on other sites. Here at Revision3 we work successfully with a number of them. TiVo, for example, provides us with a tremendous number of engaged couch potatoes. Metacafe offers a strong audience for some of our shorter-form videos. And Yahoo! – especially when something gets Buzzed – can deliver a boatload of attention. Even zany Ebaumsworld delivers strong views for our more irreverent shows, including JV's World. But we've been working closely with these outlets for a long time, and know what plays well on each of our popular partner sites – and how to successfully work together.
Oh, and I'd be remiss if I didn't mention Hulu. If any site can match YouTube for scale and share of mind, it's Hulu. But the two sites are vastly different. If you're looking for professionally produced shows that originated on broadcast or cable, Hulu is a great site. It's the top site. If you make those types of shows, then by all means develop a kissing relationship with them. But get ready for rocky times ahead. If you believe that Hulu views are cannibalistic – and I do – then every Hulu view translates into lost revenue for its corporate parents – and NBC, Fox, and Disney can hardly afford that. But that's a topic for another column – until then, you can read about how one analyst recently called Hulu a "demon seed" for its corporate parents - Report: TV Networks Should Be Afraid -- Very Afraid -- of Hulu.
But YouTube is also a search engine – and in fact it's the second largest search engine out there – aside from corporate parent Google. And that's why, with some simple optimization, you can dominate YouTube search far more easily than Google – and thus ensure that at least a meaningful fraction of those billions of views accrue to your video.
Don't think that it'll be just like optimizing for Google, though. The algorithms are very different. YouTube can't (yet) parse your video to find out what it's all about. That's radically different from Google, which spiders and reads your Web pages and categorizes based on words and links.
YouTube, instead, relies much more heavily on how you describe the video. That means you can find key terms, optimize for them, and deliver meaningful views.
"After determining the content of the video using our spidering technology, YouTube combines sophisticated text-matching techniques to find videos that are both important and relevant to your search. Our technology examines dozens of aspects of the video's content (including number of hits and rating) to determine if it's a good match for your query."
What that means, basically, is that you now have to get good at YouTube optimization, in addition to traditional Search Engine Optimization (SEO). It's so different, that I've even given it a new name – YTO, or YouTube Optimization.
How do you become good at YTO? Luckily there are some great resources online, and in the bookstore. On the Web, I recommend the insightful REEL SEO blog, along with viral-video expert Kevin Nalts' insight from the trenches. YouTube's own business blog is also a must-read.
If you'd rather peruse the printed page, video SEO expert Greg Jarboe has just released the great new book "YouTube and Video Marketing: An Hour a Day" It's a fine introduction, with case studies, into how to get the most out of YouTube. Sure you can be a big fish in a small pond – and that's absolutely one path to viewership. But if you want to really reach the mass video audience there's only one place to be. YouTube. Master its quirks, and you'll be well on the way to success in this brand new medium.


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Q: Java Audio Byte Buffer takes varying times to fill I am opening a targetdataline to accept audio input for a given format.
I start and open the line,  and I have a buffer which fills with bytes.  This runs on a constant loop until an external parameter is changed.
Now for a fixed sample rate and buffer size, I would expect this to always take the same amount of time to fill,  ie if my buffer size was 48000 for an 8 bit stream, and my sample rate was 48kHz,  I would expect my buffer to always take 1 second to fill.  However I am finding this varying greatly.
The following is the code I have used:
 DataLine.Info info1 = new DataLine.Info(TargetDataLine.class, format1);

     try (TargetDataLine line = (TargetDataLine) m1.getLine(info1)) {
         line.open(format1);
            line.start();

            while (!pauseInput){
            long time1 = System.currentTimeMillis();

            int numBytesRead1 = line.read(buffer1, 0, buffer1.length);

            //chan1double = deinterleaveAudio(buffer1, chan1selectedchannel, chan1totalchannels);
            long time2 = System.currentTimeMillis();
            System.out.println(threadName + " Capture time = " + (time2-time1));
            }
         line.stop();

     }

The commented line is a process I want to run each time the buffer is full. I realise I cannot place this here as it will interrupt the stream, so I need to find a different way to call this, hence I have commented out.
For testing purposes I have a buffer size of 4096. My audio format is 48kHz 16-bit,  so I would expect my byte buffer to be filled in 42.6ms. ((1/48000) * 2048). (this is multiplied by half the buffer size as each sample is two bytes). However using the currentTimeMillies to measure each pass it is coming back with 123ms and 250ms and varying between those times.
Is there something I am missing out here that I have not done?
EDIT:  I have copied just the code into a brand new application that doesn't even have a GUI or anything attached to it.  Purely to output to the console and see what is happening, making sure there are no background threads to interfere, and sure enough the same happens. 95% of the time the buffer with predicted fill time of 250ms fills within 255-259ms.  However occasionally this will drop to 127ms (which is physically impossible unless there is some weird buffer thing going on.  Is this a bug in java somewhere?

A: I don't think it is a good idea to adjust timing such a way. It depends on many things e.g., bufferSize, mixer, etc. Moreover, your application is sharing the line's buffer with the mixer. If you have a real-time processing, store your data in a circular buffer with a length that is good enough to hold the amount of data that you need. In another thread, read the desired amount of data from the circular buffer, and do your processing at a constant time interval. Thus, sometimes, you may overlap or miss some bytes between two consecutive processings, but you always have the expected amount of bytes.
When you open the line, you can specify the line's buffer size by using open(format, bufferSize) or you can check actual buffer size by
calling DataLine.getBufferSize(). Then you need to specify the size of your short buffer that you are providing when you retrieve data through TargetDataLine.read(). Your short buffer size has to be smaller than the line's buffer size. I would consider short buffer size as 1/4th, 1/8th, 1/16th or so of the line's buffer size. Another idea is checking the available bytes DataLine.available() before calling read(). Note that read() is a blocking call (but it doesn't block line's buffer), i.e., it will be stuck until the requested amount of bytes have been read.
For low latency direct communication between your application and audio interface, you may consider ASIO.

A: For anyone looking at the same issue, I have been given an answer which half explains what is happening.
The thread scheduler decides when the code can run, and this can cause this to vary by 10-20ms.  In the earlier days this was as much as 70ms.
This does not mean the stream is missing samples, but just that this buffer will not provide a continuous stream.  So any application look at processing this data in realtime and passing it to be written to an audio output stream needs to be aware of this extra potential latency.
I am still looking at the reason for the short buffer fill time, every four or five passes.  I was told it could be to do with the targetDataLine buffer size being different to my buffer size and just the remainder of that buffer being written on that pass, however I have changed this to be exactly the same and still no luck.

redpajama_set_name: RedPajamaStackExchange


Compact and stylish with a low seat height, the Bolt delivers both a refined and agile ride, while retaining the timeless character and soul that is a critical part of owning such an individual machine. Yamaha's unique flat line style and use of exposed metal components accentuates the bike's pure simplicity while the V-twin motor provides both spirited performance and unquestioned reliability. Stripped back and stylish, the Bolt provides a perfect entry into the world of customisation.


text:
Q: Read stream of an external process with Java What I would like to know is, can I from Java read the output stream of an external process?
Let us say this external process is a windows terminal and is not started from Java using ProcessBuilder or Runtime.exec().

A: It is possible if the external process is a predecessor in a process pipeline:
> cat file | java MyClass

then java program can read the output stream of the cat program via System.in. In other cases, I doubt it is possible even using C/C++ languages.


Phytotherapy products are formulated and tested by Prominent Physicians and Healthcare Professionals who believe in Alternative Therapies. With that in mind, they've concluded that "Prevention is better than cure" which is the promise of Phytotherapy product line. Phytotherapy has taken these products one step further and created the "TARGETED DELIVERY SYSTEM". They guarantee the delivery and utilization of the nutrients into the body.


I came across this sad bit of news via NME this morning. Sad because I already missed out on their NYC shows earlier this year at Museum Of Modern Art —and even sadder that I'm no where near Dusseldorf, Germany (Kraftwerk's hometown, btw) for this eight night series they're going to do in January.
Kraftwerk's new series of gigs is called "1 2 3 4 5 6 7 8" and will take place at Kunstsammlung Nordrhein-Westfalen Museum from January 11 – 13 and then 16 – 20 of the same month.
If you're interested in going to any of these shows, tickets go on sale tomorrow (November 10).


The slim support is hardly noticeable under clothing and is therefore inconspicuous during daily use. However, the appealing, sporty design also allows it to be worn exposed – for example if you want to wear short clothing during the summer. Depending on your tastes, you can select a neutral skin-colored or a modern silver-grey support. Especially handy: The support can be easily washed at 30° C using standard mild detergent.
In addition, the Genu Sensa is flexible and pleasant to wear. The material is breathable and skin-friendly so that you do not sweat unnecessarily underneath the support. The seam is at the side where it is not bothersome. The material has a more open design in the hollow of the knee in order to offer you the greatest possible freedom of movement and wearer comfort. After all, you should be able to pursue your daily and leisure activities without restrictions.
The support is knitted in the shape of your knee joint and therefore adapts ideally to your knee. The upper and lower edges are knitted slightly softer so that they do not cut into the skin; this allows the Genu Sensa to be worn over longer time periods without any problems. The active support not only helps relieve your pain, but also helps provide sustained relief and stabilization of your knee. Swelling and contusions are reduced.


Our instructors and mentors experience, skills and knowledge are uniquely beneficial to your school ensuring you meet the challenges placed on children and teachers in the classroom.
UK Military School employ veterans and reservists from the British armed forces. The British values of freedom, tolerance, acceptance of personal and social responsibility as well as upholding the rule of law are attributes we live by every day.
These values are represented through our core values and standards. We believe by focusing on these we can make a difference to children's lives and improve performance in the classroom.
Our instructors below will tell you more about the brilliant programmes we offer for schools in the UK.
Are you post 16 and interested in joining our Protective Services Academy?
Are you post 16 and keen for a career in The Protective Services? , well The UK Military Schools sister company 'The Protective Services Academy' launched in August 2018 offering post 16 students a full time education to those who have an interest in joining the 'Protective Services Sector' . If you would like a career in the Army, Navy, RAF, Police, Fire, Ambulance service, HM Prison and Probation Service, HMRC, Border force, Maritime and Coastguard Agency, RNLI and Mountain Rescue Service then why wait longer ? Our academy is for you. By joining us you can gain a BTEC Level 3 in Uniformed Public Services qualification delivered by experienced and knowledgeable ex-soldiers who will provide you with all the tools you need before moving off in to your chosen career.
You will take part in new tasks, meet new challenges and make new friends and be able to make the right career choice. To find out more, visit our Academy page and fill out our sign-up form.


The introduction of the EU's stringent new GDPR data protection laws make effective employee onboarding a critical part of any HR operation.
The legislation requires HR teams have an unprecedented level of control over the information they collect and store on incoming employees.
General Data Protection Regulation (GDPR) covers everything from how and why employee information is collected, to the way an organization stores and deletes its data.
It's a challenge that traditional approaches to onboarding - relying on phone calls, spreadsheets and paper documents - will struggle to meet. The recent survey from webonboarding shows that 68% of HR teams still use manual employee onboarding methods, that include phone, email and post.
The combination of paper-based management and manual processes create an onboarding system in which information becomes dangerously scattered across an organization in multiple formats.
The more hires a HR team handles, the worse this problem becomes with outdated, duplicate and legacy information getting easily lost in the system. Added to this is the risk of human error as bulk data is managed manually.
And the consequences for businesses who breach GDPR rules are serious - Article 83 sets out a maximum fine of €20 million or 4% of annual turnover, whichever is greater.
Only a robust and efficient onboarding process can effectively deliver the level of data management that's now required by GDPR.
From the moment an offer is made the system tracks and manages all of the data that's exchanged between HR, hiring managers and incoming employees.
Employers need to be clear about what data is collected and why.
Requirement to collect only employee data that's necessary.
Employer must ensure that information is accurate and valid.
Data must be monitored to ensure relevance and removed when no longer necessary.
Employers must now accept full responsibility for data security.
The guide to employee onboarding compliance series will look at each one of these key principles in greater depth - identifying the issues raised and highlighting the ways that a cloud-based system can solve them.


On Thursday August 24th, at a Lentil as Anything Pop-up, Hey Prest in Preston, you can learn how to make kimchi.
Rutherglen in the City will bring the essence and wines of the iconic Rutherglen wine region giving Melburnians the opportunity to taste and learn more about the region's unique wine varietals and its winemakers.
If you are a wine lover, you won't want to miss this special opportunity to discover the boutique Montara Wines label.
What better way to warm up on a cold winter's night than with hot fresh pretzels and pizza accompanied by a beer with a stunning head.
Bendigo On The Hop has long been touted as Australia's best winter craft beer festival and this year will showcase the product of 20 of the countries top independent and Australian owned craft breweries at ten venues in and around Bendigo.
You can be sure there'll be lots to keep you entertained and amused.
While you're there why not take a step back in time and enjoy the history on display at the Briars Historic Park, particularly the homestead built in 1851 and occupied by Alexander Balcombe.
The Wattle Festival Night Market is the final act featured in the Hurstbridge Wattle Festival on Sunday 27th August 2017.


Young men play in the water, that the thousand year old aflaj system has gathered, drained on the mountains, and then channelled into the storage pool of this date palm grove, where it will be used for irrigation. Oman is a nation of 3 million inhabitants that has obtained food self-sufficiency, an extraordinary goal for a country that is mostly desert. Indeed, Oman's merit is also the ability to wisely manage its water resources, restoring and preserving its traditional water system and water plants.
LabOasis Foundation was founded in 2015 from a commitment to support the communities that inhabit the Saharan and Arabic Oases, and to avert the loss of their cultural and environmental heritage, now threatened by climate change and destructive human activities, in parallel with the advancement of the world-wide phenomena of desertification. LabOasis Foundation is engaged in raising awareness of the age-old wisdom which allowed the Oases to overcome the shortage of primary resources, and that today – more than ever – has become an important reference for any human settlement. This is because, in areas located far apart and within different nations – in what looks like an extended permanent laboratory – the people of the desert have never ceased to test practices to ensure their livelihoods and food security. Hence, LabOasis Foundation works to contrast the definitive disappearance of these ecosystems, their biodiversity, and the beauty of a landscape which is entirely created by man, in extreme environmental conditions. To encourage projects on the ground, combining traditional knowledge with innovation, is one of our main goals. To develop eco-friendly actions, that promote social welfare and protect these communities' cultural identities, is still possible. Since prehistoric times the Oases have been at the crossroads of ancient caravan routes, the scene of fruitful cooperation between different peoples. For thousands of years, settlers and nomads, Arabs, Berbers, Blacks, producers and traders, Muslims, Jews, Christians and Animists, have all participated in creating a common market, where the exchange of goods favoured a multi-faceted transfer of cultural and religious values. Keeping alive this tradition of hospitality, peaceful coexistence and tolerance, deeply inscribed in the DNA of communities often settled in border areas and along today's Saharan migration routes, is a responsibility for everyone. Supporting the traditional integrated economy of the Oases, promoting the restoration of their architectural heritage, entirely built in raw earth or stone, to better withstand the local climatic conditions, are equally important actions. We seek, specifically, to counter youth emigration and the abandonment of historic villages. To this end, for the defence of these peoples, these places and their history, an important step will be taken when the particular nature and uniqueness of the Oases Civilization will be fully recognized by national and international institutions. This is the achievement towards which LabOasis Foundation has been working from day one: establishing of a World Oases Day.
Global warming, desertification, water crises, and migration emergencies are processes that are largely ascribable to human action. Therefore, global agreements, and also a great number of local initiatives are called for. Rainfall can be beneficial or destructive, depending on soil management.
We will have water to live on, depending on the systems we use to collect, preserve and employ it for irrigation. We will have food security depending on how we choose to farm our planet.
We will or will not witness the displacement and migration of entire populations, depending on what kind of habitat they will have to live in. We will be able to preserve the fragile beauty of our world, depending on the footprints we leave on the ground, and for this reason we need a model on which to base the effectiveness of our actions.
The Oasis, created by the people of the desert, and the product of a virtuous interaction with the environment that can guarantee the prosperity of entire communities in extreme climatic conditions, is that model. To effectively defend such social capital and the places where it takes roots, preserving its precious body of knowledge and the beautiful landscapes it has generated is the challenge that LabOasis Foundation has taken up and a commitment for each and every one of us. More heat, more thirst, more refugees, more walls. This must not be our future.


objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases.
surrounding exposure estimates and relative risks.
results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group.
water, community sewage with treatment and hand hygiene.


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What would your response be if I asked you to walk and run 100km in the Australian bush with me? You'd be part of a team of four and we'd be raising money for the Oxfam Trailwalker. Would you have thought you couldn't do it? That the human body isn't meant to do that kind of thing? It was mad? These were the kind of responses from most people… or that they happened to be busy that weekend!
I eventually found three others who were keen to take on the challenge. We formed a team and hit the ground running, so to speak. Not only is it a physically demanding event, all four team members must complete the 100km course together, everyone must check-in at all the designated checkpoints and make it over the finish line within 48 hours.
Leaving the house in the wee hours of the morning of Friday 10 April, the course started off at Wesburn Park and ran through the Dandenong Ranges, covering some beautiful country. We travelled over the mountains into Warburton, onto the O'Shannassy Aquaduct and along the flat section of the Warburton Trail. From there we moved up to the peak of Olinda, down through Ferntree Gully, Lysterfield and finally finished in Jells Park Wheelers Hill.
There were times throughout the 100km course where our bodies felt like they'd gone as far as they could, our brains were telling us to stop and the thought of a hot shower was almost enough to make you want to throw in the towel and raise a white flag. But, as with most challenging situations, whether they are physical, mental or both – we actually had a lot more in the tank than we realised. It's called the 85/15 principle.
This principle was first introduced to me by a seasoned Oxfam Trailwalker participant, who has a background in medicine. She told me the Oxfam 100km is actually a piece of cake, provided you do your training. When you think you're near exhaustion at say 85% of your physical limits – ignore it. You're actually at 15% and have 85% of your capacity in reserve. I was intrigued.
She said the human body is amazing in terms of its strength and underlying capability and sometimes we should ignore our natural instincts, reservations and doubts. Those reference points to exertion and the physical boundaries we place on ourselves are in our minds and you actually just need to keep pushing through.
It can be the same in our professional and personal lives. Whether we are mentally challenged by solving a difficult problem, managing multiple projects with competing deadlines, or feel like we don't have enough resources to successfully deliver – once you've solved the problem, delivered the projects and completed what you thought was unachievable, it reminds us we are capable of so much more than we think.
Our team of four completed the Oxfam Trailwalker together in 20 hours and 45 minutes, finishing at 4:45am on Saturday 11 April, and I'll tell you what – we couldn't wipe the smiles off our tired and grubby faces. While the event certainly took us out of our comfort zones, we all took on board a valuable lesson. Next time you're confronting a serious challenge, try the 85/15 principle: When you feel like you're at 85% of your limits, flip it around and know you're capable of much, much more than you're giving yourself credit for.
I think most of us have probably been guilty of underestimating our own capability at some point throughout our lives, as well as the true potential of what our colleagues, clients, friends and family can achieve. We are far more likely to achieve our goals when we ignore our doubts and just get on with it, while supporting others to do the same.
What challenges have you set for yourself to take you out of your comfort zone?


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68 competitors had to complete 5k with 310m of ascent before descending back to the Pinemartin Cafe.
SLT now sit seventh in the league.
Nine goals made it an easy win for Mallaig.
Fraserburgh had four goals disallowed in the first half.
From vaulting to floor routines, there was plenty of action in the Nevis Centre.
The first jack of the season was thrown at the Inverlochy green on Saturday.
Fort William Football Club has issued a statement saying it was 'extremely saddened' to discover that a deer had died.
Sign up for The Oban Times Newsletters to get updates on our top stories.


In an advance with overtones of Star Trek phasers and other sci-fi ray guns, scientists in Canada are reporting development of an internal on-off "switch" that paralyzes animals when exposed to a beam of ultraviolet light. The animals stay paralyzed even when the light is turned off. When exposed to ordinary light, the animals become unparalyzed and wake up. Their study appears in the Journal of the American Chemical Society (JACS). It reports the first demonstration of such a light-activated switch in animals.
Neil Branda and colleagues point out that such "photoswitches" — light-sensitive materials that undergo photoreactions — have been available for years. Scientists use them in research. Doctors use light-sensitive materials and photoreactions in medicine in photodynamic therapy to treat certain forms of cancer. Those light-sensitive materials, however, do not have the reversibility that exists in photoswitching.
The JACS report describes development and successful testing of a photoswitch composed of the light-sensitive material, dithienylethene. The scientists grew transparent, pinhead-sized worms (C. elegans) and fed them a dithienylethene. When exposed to ultraviolet light, the worms turned blue and became paralyzed. When exposed to visible light, the dithienylethene became colorless again and the worms' paralysis ended. Many of the worms lived through the paralyze-unparalyze cycle. Scientists were not sure how the switch causes paralysis. The study demonstrates that photoswitches may have great potential in turning photodynamic therapy on and off, and for other applications in medicine and research, they indicate.


A California judge has appointed Steve Berman as interim co-lead counsel.
Hagens Berman is co-lead counsel in this antitrust class-action lawsuit filed against Panasonic claiming that the electronics giant manipulated the resistor market, leading to increased prices and harm to consumers.
A resistor is a passive two-terminal electrical component that implements electrical resistance as a circuit element and a common element in electronic equipment including cell phones and computers, as well as many industries including telecommunications, audiovisual, automotive and server computing.
The suit alleges violations of Section One of the Sherman Act, as well as antitrust, consumer-protection and unfair competition laws in California and New York.
The suit has been filed on behalf of a class of indirect purchasers, including small businesses, and seeks damages and injunctive relief against Panasonic, as well as KOA Corporation; KOA Speer Electronics, Inc.; Murata Manufacturing Co., Ltd.; ROHM Co., Ltd.; Vishay Intertechnology, Inc.; Yageo Corporation for the collusion.
In his order appointing Hagens Berman's Steve Berman as co-lead counsel, Judge Ronald M. Whyte of the U.S. District Court in San Jose stated that the cadidates, "are capable and accomplished advocates, with extensive experience in complex litigation, including class actions and cases involving technology and antitrust claims."
The eight consolidated cases are Resistors Antitrust Litigation, case number 5:15-cv-03820, in the U.S. District Court for the Northern District of California.


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Brooks Orpik
Defenseman
Height: 6'2" (188) | Weight: 219 (99)
Shoots: Left
2008-09 Team: Pittsburgh Penguins
2014 Olympic Winter Games, 4th
2010 Olympic Winter Games, silver medalist
USA HOCKEY EXPERIENCE:
2005-06: Appeared in all seven games for Team USA at the2006 IIHF Men's World Championship. 1999-00: Skated for the U.S. National Junior Team at the 2000 IIHF World Junior Championship … Registered a goal and an assist.
NHL EXPERIENCE:
With Pittsburgh: 2008-09: Completed his fifth full season with the National Hockey League's Pittsburgh Penguins … Appeared in 79 regular-season games … Ranked second among team defensemen in assists (17), third in plus/minus (+10) and tied for third in points (19) … One of only two Pittsburgh defenseman with a game-winning goal … Added four assists in 24 playoff games and helped the Penguins win the Stanley Cup. 2007-08: Skated in 78 regular-season games and registered one goal and 10 assists … Finished year with career-best +11 … Played in 20 playoff games and notched two assists … Helped Pittsburgh reach Stanley Cup Final.
2006-07: Appeared in 70 regular-season games … Tallied six assists … Skated in five playoff games.
2005-06: Skated in 64 games and accumulated nine points (2-7).
2003-04: Played in 79 games and tallied one goal and nine assists.
2002-03:Appeared in six games.
ADDITIONAL EXPERIENCE:
Appeared in 152 regular-season games over three years (2001- 04) for the Wilkes-Barre/Scranton Penguins of the American Hockey League … Skated in three regular-season games during the 2003-04 season … Played in 24 playoff games and tallied four assists … In 2002-03, appeared in 71 regular-season games and recorded four goals and 14 assists … Skated in six playoff games … In 2001-02, played in 78 regular-season games and notched 20 points (2-18) … Played three seasons for Boston College (1998-2001) of the Hockey East Association … In 2000-01, helped the Eagles win the NCAA championship … Appeared in 40 games and registered 20 assists … As a sophomore in 1999-00, tallied one goal and nine assists in 38 games … Appeared in 41 games as a freshman in 1998-99, scoring one goal and registering 10 assists.
PERSONAL: Selected with Pittsburgh's first-round (18th overall) pick in the 2000 NHL Entry Draft … Born In 1980, in San Francisco, Calif.
James Harden, Erik Johnson And 16 Other Olympians Are Still Going Strong In The NBA And NHL Playoffs
Chrös McDougall April 24, 2019
Golden State has six Olympians, while the Sharks rallied around injured captain Joe Pavelski to clinch a huge win.
With NBA And NHL Playoffs Underway, How Are The Team USA Athletes Performing?
Maggie Hendricks April 17, 2019
Five Olympians are rolling with the Golden State Warriors, and more than a dozen set out for the Stanley Cup.
29 Olympians Ready To Take The Ice In Upcoming NHL Season
Ryan Williamson Oct. 01, 2018
Three players from the 2018 Olympic team will begin their first full season in the NHL.
Olympic Hockey Players Ready To Face Off For NHL Season
Stuart Lieberman Oct. 07, 2014
All 25 U.S. Olympians from Sochi squad return to the NHL this season
U.S. Tops Czechs 5-2, Moves To Olympic Hockey Semis
Kimiya Shokoohi Feb. 19, 2014
Team USA will play Canada in semifinal Friday
Gallery: USA, Russia Meet In Marathon On Ice
T.J. Oshie's four shootout goals lift Team USA over Russia
Video: Road To Sochi: Men's and Women's Hockey Are Gearing Up For Sochi
One Goal For Men's Ice Hockey Team: Gold
Paul D. Bowker Jan. 01, 2014
Twenty-five players, 13 with Olympic experience, are nominated to 2014 U.S. Olympic Men's Ice Hockey Team after NHL Winter Classic
The U.S. Men's Hockey Team Is Gearing Up For Sochi