Introduction: historical perspective and development of amoxicillin/clavulanate

Infections are currently ranked as the leading global burden of disease with respiratory diseases playing the most significant role. Antibiotic resistance remains a serious problem, as it was even 50 years ago. The 1970s saw the introduction of a number of important new antimicrobial agents, such as amoxicillin, but despite a high level of clinical success, a serious mechanism of resistance had emerged which could render the penicillins inactive – beta-lactamase production. In 1972, a potent inhibitor of beta-lactamase was identified. It was produced by Streptococcus clavuligerus and named clavulanic acid. Amoxicillin, with its good oral absorption and broad spectrum antimicrobial activity, was chosen as the antibiotic to be co-administered with clavulanic acid and, in tablet formulation, was launched as Augmentin in the UK in 1981. Today, although there are currently new antibacterial compounds in development, most are at a pre-clinical stage. It is thus necessary to make the best use of currently available agents. The development of higher dosing regimens and pharmacokinetically-enhanced formulations has allowed amoxicillin/clavulanate to continue to play an important role in the treatment of a range of infections, particularly those of the respiratory tract, in both adults and children worldwide.