amoxicillin trihydrate


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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.

amoxicillin trihydrate (əmok´səsil´in trīhī´drāt),

n brand names: Amoxil, Apo-Amoxi, Novamoxin, Nu-Amoxi and others;
drug class: aminopenicillin;
action: interferes with cell wall replication of susceptible organisms;
uses: sinus infections, pneumonia, otitis media, skin, urinary tract infections. This is a drug of choice for antibiotic premedication for patients at risk for bacterial endocarditis unless there is an allergy to penicillin-related antibiotics.
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