Introduction
Antimicrobial resistance is one of the defining public health challenges of our time. And yet, one of the most effective responses available to clinicians is not a new drug — it’s using an existing one more wisely.
In Episode 15 of The Critical Care Commute, Leon and Peter sit down with Dr. George Zhanel, Distinguished Professor at the Max Rady College of Medicine and one of Canada’s foremost experts in antimicrobial pharmacology, to make the case for IV Amoxicillin-Clavulanate as an underutilised cornerstone of antibiotic stewardship.
What Is IV Amox-Clav?
Amoxicillin-Clavulanate has been available in oral form since the 1980s. The intravenous formulation opens new clinical territory for hospitalised patients who require parenteral therapy but do not need the full spectrum of piperacillin-tazobactam or a carbapenem.
Its coverage includes a clinically meaningful range of gram-positive organisms (including S. pneumoniae and MSSA), gram-negative organisms (including E. coli and Klebsiella), and anaerobes — including Bacteroides fragilis. This makes it viable for a broad range of community-acquired infections including pneumonia, urinary tract infections, skin and soft tissue infections, and intra-abdominal infections.
The CLEAR Registry: Real-World Outcomes
The CLEAR (Canadian Leadership on Antimicrobial Real-Life Usage Registry) project has collected prospective data on IV Amox-Clav use across Canada. As of mid-2024:
– Over 550 clinicians are participating
– Clinical success rates exceed 85% across infection types
– The drug has been used effectively even when bacteremia is present
– In 50% of cases, treatment was started empirically — before pathogen identification — with strong outcomes
This is not theoretical data. This is how Canadian clinicians are already using IV Amox-Clav — and it is working.
The Stewardship Argument
Dr. Zhanel’s core argument is straightforward: antimicrobial stewardship is not about restriction. It is about precision. Using the right drug, at the right dose, for the right infection, for the right duration.
IV Amox-Clav represents a legitimate de-escalation option from piperacillin-tazobactam, ceftriaxone, and in selected cases, meropenem — in patients with community-acquired infections caused by susceptible organisms. Every appropriate de-escalation preserves broader-spectrum agents for the patients who will genuinely need them.
Knowing what IV Amox-Clav does NOT cover is equally important: it has no activity against MRSA, Pseudomonas aeruginosa, ESBL-producing organisms, or Acinetobacter. Patient selection is everything.
Listen to Episode 15
The Critical Care Commute Episode 15 — Antibiotic Stewardship: IV Clavulin — is available now on Spotify and all major podcast platforms. Dr. Zhanel walks through the clinical evidence, the CLEAR registry data, and the practical decision-making framework for incorporating IV Amox-Clav into your stewardship practice.
Share it with your antimicrobial stewardship team, your ICU pharmacist, and anyone who prescribes antibiotics in your hospital.
Smarter stewardship starts with a better understanding of what we already have.
🎧 Spotify: https://open.spotify.com/episode/0ObcsRAZjk0InHFzuta90R?si=YMXIRQoRQwmijDPmR2Armg
#CriticalCare #FOAMcc #ICU #MedEd #TheCriticalCareCommute #AntibioticStewardship #AMR #CLEARRegistry
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