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Amoxycillin

ANTIBIOTICS & ANTIINFECTIVES

PENICILLINS - [ ANTIBIOTICS & ANTIINFECTIVES ]

Amoxycillin Amoxicillin is penicillinase-susceptible semi-synthetic penicillin. It is active against meningococci and L. monocytogenes are sensitive to this class of drugs. H. influenzae and the viridans group of streptococci exhibit varying degrees of resistance. Enterococci and most strains of N. gonorrhoeae, E. coli, P. mirabilis, Salmonella, and Shigella were highly susceptible but an increasing percentage of these species now are resistant. From 30% to 50% of E. coli, a significant number of P. mirabilis, and practically all species of Enterobacter presently are insensitive (1)

Infections of the ear, nose, and throat – due to Streptococcus spp. (α- and β-hemolytic strains only), S. pneumoniae, Staphylococcus spp., or H. influenzae Infections of the genitourinary tract – due to E. coli, P. mirabilis, or E. faecalis. Infections of the skin and skin structure – due to Streptococcus spp. (α- and β-hemolytic strains only), Staphylococcus spp., or E. coli. Infections of the lower respiratory tract – due to Streptococcus spp. (α- and β-hemolytic strains only), S. pneumoniae, Staphylococcus spp., or H. influenzae. Gonorrhea, acute uncomplicated (ano-genital and urethral infections) – due to N. gonorrhoeae (males and females) in combination with clarithromycin plus lansoprazole as triple therapy, is indicated for the treatment of patients with H. pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori. (2)

A history of allergic reaction to any of the penicillins is a contraindication. (2)

Infections and Infestations: Mucocutaneous candidiasis. Gastrointestinal: Nausea, vomiting, diarrhea, black hairy tongue, and hemorrhagic/pseudomembranous colitis. Hypersensitivity Reactions: Anaphylaxis, Serum sickness–like reactions, erythematous maculopapular rashes, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported. A moderate rise in AST (SGOT) and/or ALT (SGPT) has been noted, but the significance of this finding is unknown. Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis have been reported Crystalluria has also been reported Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena Reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral changes, and/or dizziness have been reported rarely (2)

Probenecid decreases the renal tubular secretion of amoxicillin. Concurrent use of amoxicillin and probenecid may result in increased and prolonged blood levels of amoxicillin. Chloramphenicol, macrolides, sulfonamides, and tetracyclines may interfere with the bactericidal effects of penicillin. This has been demonstrated in vitro; however, the clinical significance of this interaction is not well documented. In common with other antibiotics, it may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives. (2)

Oral ampicillin-class antibiotics are poorly absorbed during labor Penicillins have been shown to be excreted in human milk. Amoxicillin use by nursing mothers may lead to sensitization of infants. Caution should be exercised when amoxicillin is administered to a nursing woman Because of incompletely developed renal function in neonates and young infants, the elimination of amoxicillin may be delayed This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function (2)

Capsules, chewable tablets, and oral suspensions of amoxycillin may be given without regard to meals. The 400-mg suspension, 400-mg chewable tablet, and the 875-mg tablet have been studied only when administered at the start of a light meal. However, food effect studies have not been performed with the 200-mg and 500-mg formulations. Neonates and Infants Aged ≤12 Weeks (≤3 Months): Due to incompletely developed renal function affecting elimination of amoxicillin in this age group, the recommended upper dose of dose is is 30 mg/kg/day divided q12h For mild to moderate infection of Lower Respiratory Tract, Skin/Skin Structure, Genitourinary Tract: 500 mg every 12 hours or 250 mg every 8 hours For severe infections: 875 mg every 12 hours or 500 mg every 8 hours Gonorrhea Acute, uncomplicated ano-genital and urethral infections in males and females: 3 grams as single oral dose (2)

1. William A. Petri Jr. Penicillins, Cephalosporins and Other β-Lactam Antibiotics. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. p1477-1503. 2. AMOXIL [Internet]. [cited 2013 Aug 27]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050542s24,050754s11,050760s10,050761s10lbl.pdf 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011