amoxicillin

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amoxicillin

 [ah-moks″ĭ-sil´in]
an antibiotic that is a penicillin analogue similar in action to ampicillin but more efficiently absorbed from the gastrointestinal tract and therefore requiring less frequent dosage and not as likely to cause diarrhea.

amoxicillin, amoxicillin trihydrate

Amix (UK), Amox (CA), Amoxident (UK), Amoxil, Apo-Amoxil (CA), Moxatag (CA), Novamoxin (CA), Nu-Amoxil (CA), Trimox

Pharmacologic class: Aminopenicillin

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Inhibits cell-wall synthesis during bacterial multiplication, leading to cell death. Shows enhanced activity toward gram-negative bacteria compared to natural and penicillinase-resistant penicillins.

Availability

Capsules: 250 mg, 500 mg

Powder for oral suspension: 50 mg/ml and 125 mg/5 ml (pediatric), 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

Tablets: 500 mg, 875 mg

Tablets for oral suspension: 200 mg, 400 mg

Tablets (chewable): 125 mg, 200 mg, 250 mg, 400 mg

Indications and dosages

Uncomplicated gonorrhea

Adults and children weighing at least 40 kg (88 lb): 3 g P.O. as a single dose

Children ages 2 and older weighing less than 40 kg (88 lb): 50 mg/kg P.O. given with probenecid 25 mg/kg P.O. as a single dose

Bacterial endocarditis prophylaxis for dental, GI, and GU procedures

Adults: 2 g P.O. 1 hour before procedure

Children: 50 mg/kg P.O. 1 hour before procedure

Lower respiratory tract infections caused by streptococci, pneumococci, non-penicillinase-producing staphylococci, and Haemophilus influenzae

Adults and children weighing more than 20 kg (44 lb): 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours

Children weighing less than 20 kg (44 lb): 45 mg/kg/day P.O. in divided doses q 12 hours or 40 mg/kg/day P.O. in divided doses q 8 hours

Ear, nose, and throat infections caused by streptococci, pneumococci, non-penicillinase-producing staphylococci, and H. influenzae; GU infections caused by Escherichia coli, Proteus mirabilis, and Streptococcus faecalis

Adults and children weighing more than 20 kg (44 lb): 500 mg P.O. q 12 hours or 250 mg P.O. q 8 hours

Children weighing less than 20 kg (44 lb): 45 mg/kg/day P.O. in divided doses q 12 hours or 20 to 40 mg/kg P.O. in divided doses q 8 hours

Eradication of Helicobacter pylori to reduce risk of duodenal ulcer recurrence

Adults: 1 g P.O. q 12 hours for 14 days in combination with clarithromycin and lansoprazole, or in combination with lansoprazole alone as 1 g t.i.d. for 14 days

Postexposure anthrax prophylaxis

Adults: 500 mg P.O. t.i.d. for 60 days

Children: 80 mg/kg/day P.O. t.i.d. for 60 days

Skin and skin-structure infections caused by streptococci (alpha- and beta-hemolytic strains), staphylococci, and E. coli

Adults: 500 mg P.O. q 12 hours to 250 mg P.O. q 8 hours. For severe infections, 875 mg P.O. q 12 hours or 500 mg P.O. q 8 hours.

Children older than age 3 months: 25 mg/kg/day P.O. in divided doses q 12 hours or 20 mg/kg/day P.O. in divided doses every 8 hours. For severe infections, 45 mg/kg/day P.O. in divided doses q 12 hours or 40 mg/kg/day P.O. in divided doses every 8 hours.

Dosage adjustment

• Renal impairment

• Hemodialysis

• Infants ages 3 months and younger

Off-label uses

Chlamydia trachomatis infection in pregnant patients

Contraindications

• Hypersensitivity to drug or any penicillin

Precautions

Use cautiously in:

• severe renal insufficiency, infectious mononucleosis, hepatic dysfunction

• pregnant patients.

Administration

Ask about history of penicillin allergy before giving.

• Give with or without food.

• Store liquid form in refrigerator when possible.

• Know that maximum dosage for infants ages 3 months and younger is 30 mg/kg/day divided q 12 hours.

Adverse reactions

CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, dizziness, fatigue, hyperactivity, insomnia, behavioral changes, seizures (with high doses)

GI: nausea, vomiting, diarrhea, bloody diarrhea, abdominal pain, gastritis, stomatitis, glossitis, black "hairy" tongue, furry tongue, enterocolitis, pseudomembranous colitis

GU: vaginitis, nephropathy, interstitial nephritis

Hematologic: eosinophilia, anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, hemolytic anemia, agranulocytosis, bone marrow depression

Hepatic: cholestatic jaundice, hepatic cholestasis, cholestatic hepatitis, nonspecific hepatitis

Respiratory: wheezing

Skin: rash

Other: superinfections (oral and rectal candidiasis), fever, anaphylaxis

Interactions

Drug-drug. Allopurinol: increased risk of rash

Chloramphenicol, macrolides, sulfonamides, tetracycline: decreased amoxicillin efficacy

Hormonal contraceptives: decreased contraceptive efficacy

Probenecid: decreased renal excretion

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, eosinophils, lactate dehydrogenase: increased levels

Granulocytes, hemoglobin, platelets, white blood cells: decreased values Direct Coombs' test, urine glucose, urine protein: false-positive results

Drug-food. Any food: delayed or reduced drug absorption

Drug-herbs. Khat: decreased antimicrobial efficacy

Patient monitoring

• Monitor for signs and symptoms of hypersensitivity reaction.

Evaluate for seizures when giving high doses.

• Monitor patient's temperature and watch for other signs and symptoms of superinfection (especially oral or rectal candidiasis).

Patient teaching

Instruct patient to immediately report signs and symptoms of hypersensitivity reactions, such as rash, fever, or chills.

• Tell patient he may take drug with or without food.

• Tell patient not to chew or swallow tablets for suspension, because they're not meant to be dissolved in mouth.

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

• Tell patient taking hormonal contraceptives that drug may reduce contraceptive efficacy. Suggest she use alternative birth control method.

• Inform patient that drug lowers resistance to other types of infections. Instruct him to report new signs and symptoms of infection, especially in mouth or rectum.

• Tell parents they may give liquid form of drug directly to child or may mix it with foods or beverages.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

a·mox·i·cil·lin

(ă-mok'si-sil'in),
A semisynthetic penicillin antibiotic with an antimicrobial spectrum similar to that of ampicillin.

amoxicillin

(ə-mŏk′sĭ-sĭl′ĭn)
n.
A semisynthetic penicillin, C16H19N3O5S, having an antibacterial spectrum of action similar to that of ampicillin.

amoxicillin

Infectious disease A broad-spectrum semisynthetic penicillin with activity similar to that of ampicillin

amoxicillin

Amoxycillin, an AMPICILLIN-like penicillin antibiotic, effective in TYPHOID and many other infections. Brand names are Amoxil and Galenamox. Compounded with lansoprazol and clarithromycin it is marketed as Heliclear.

a·mox·i·cil·lin

(ă-mok'si-sil'in)
A semisynthetic penicillin antibiotic with an antimicrobial spectrum similar to that of ampicillin.
References in periodicals archive ?
in another retrospective study set in an US hospital, with the same population (hospitalized children between 3 months old and 18 years old) in a 15-month period (May 2011-July 2012), had an opposite result, reporting that 63,6% of the pediatric CAP were treated with aminopenicillins and only 16.8% with third-generation cephalosporins [80].
Aminopenicillins were completely avoided by more than 60% of all Thai physicians, while about half of them considered carbapenem and monobactam "prescribable." First generation cephalosporins would be completely avoided by 48.3% of allergists or prescribed with precaution by 41.4%.
Antimicrobial drugs were assigned to one of the following categories: tetracyclines (doxycycline, tetracycline), macrolides (azithromycin, clarithromycin, erythromycin), fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin, gatifloxacin), aminopenicillins (amoxicillin, amoxicillin/clavulanate), cephalosporins (primarily cefuroxime and cefprozil), sulfonamides (trimethoprim-sulfamethoxazole), and other.
Antibacterial exposure in 388 Wayampi Amerindians from three villages in southern French Guyana during the year preceding the study (a) Frequency of antibacterial exposure in (%) Antibacterial agents TS (n = 85) YP (n = 55) Z (n = 248) Aminopenicillins 5.9 14.6 23.8 Metronidazole 16.5 30.9 32.3 Macrolides 8.2 1.8 11.3 Other 5.8 7.3 8.9 Overall 36.5 54.6 76.2 Frequency of antibacterial exposure in (%) Antibacterial agents Total (N = 388) p value (b) Aminopenicillins 18.6 0.007 Metronidazole 28.6 0.15 Macrolides 9.3 0.2 Other 8.0 0.7 Overall 64.4 0.007 (a) Frequency of antibacterial exposure was calculated by dividing the number of all antibacterial courses during the year preceding the study by the number of persons in each village.
(17) Quinolones (25%), macrolides (20%), and aminopenicillins (12%) were most commonly prescribed, and antibiotic prescriptions were most often written for respiratory conditions, such as bronchitis, for which we now know antibiotics are rarely indicated.
baumannii has several innate resistance mechanisms to a number of antibiotics, such as aminopenicillins, first-and second- generation cephalosporins and chloramphenicol.
Many isolates of Acinetobacter spp have developed resistance to antibiotics, including until now successful, aminopenicillins, ureidopenicillin, cefamandole and cephalothin, cephamycin, cefoxitin, most of the aminoglycosides, chloramphenicol, tetracycline, and the more recent antibiotics, such as cefotaxime, ceftazidime, imipenem, tobramycin, amikacin, and fluoroquinolones [17].
The main risk factors were more than three UTI episodes in the preceding year, usage of beta-lactam antibiotics in the preceding 3 months, and prostatic disease ([19]) In the study carried out in a tertiary training hospital in Switzerland, the analysis of UTI risk factors occurring due to community acquired ESBL-producing E.coli were: older age, female gender, diabetes mellitus, recurrent UTI, invasive urological procedures, and prior use of antibiotics such as aminopenicillins, cephalosporins or fluoroquinolones ([14]).
We found that the UPEC strains had a higher level of resistance against aminopenicillins (ampicillin (85%) and amoxicillin (65%)) and a lower level of resistance against amoxicillin-clavulanic acid (25%).
As shown by our study and some previous studies, (20,22,30) aminopenicillins, ciprofloxacin and co-trimoxazole may not be appropriate choices for empirical treatment of UTI in our setting.
It has been reported that aminopenicillins and macrolides cause more than 90% of cases of drug-induced AGEP.
Escherichia coli infections in chickens can usually be treated with potentiated sulfonamides, aminopenicillins, colistin, tetracyclines, spectinomycin, aminoglycosides, and enrofloxacin.