First Successful Use of Low Dose Amoxicillin-Clavulanic Acid in Management of Drug Resistant Tuberculosis

Resistance to anti-tuberculosis drugs is a formidable obstacle to effective tuberculosis (TB) care. A case of Pre-XDR (Pre-Extensive Drug Resistant) pulmonary TB was reported with limited therapeutic options, where low dose amoxicillin-clavulanic acid was used as an integral component of a successful regime for the first time in medical literature. World health organisation recommends giving amoxicillin-clavulanate along with meropenem as one of the therapeutic options in drug resistant tuberculosis, where clavulanate and not amoxicillin is being relied upon for anti TB activity. However, across the spectrum of dosage of amoxicillin-clavulanate combination, the dose of clavulanate is constant at 125 mg, whereas the dose of amoxicillin varies at 250 mg, 500 mg and 875 mg. This explains the rationale behind the use of low dose amoxicillin-clavulanate in combination with meropenem as a part of treatment regime for drug resistant TB.