Amoxicillin

Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability

Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Test Interactions
Mental Health: Effects on Mental
Status
Mental Health: Effects on
Psychiatric Treatment
Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions
Dental Health: Effects on Dental
Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(a moks i SIL in)
U.S. Brand Names
Amoxil; Biomox; Trimox; Wymox
Generic Available
Yes
Canadian Brand Names
Apo-Amoxi; Novamoxin; Nu-Amoxi; Pro-Amox
Synonyms
Amoxicillin Trihydrate; Amoxycillin; p-Hydroxyampicillin
Pharmacological Index
Antibiotic, Penicillin
Use
Dental: Antibiotic for standard prophylactic regimen for dental patients who are at
risk
Medical: Treatment of otitis media, sinusitis, and infections caused by susceptible

organisms involving the respiratory tract, skin, and urinary tract; prophylaxis of
bacterial endocarditis in patients undergoing surgical or dental procedures;
approved in combination with clarithromycin and lansoprazole for eradication of
H. pylori; in patients with active duodenal ulcer disease or a 1-year history of
duodenal ulcer. The combined use of lansoprazole and amoxicillin is approved for
patients unable to take clarithromycin.
Pregnancy Risk Factor
B
Contraindications
Hypersensitivity to amoxicillin, penicillin, or any component
Warnings/Precautions
In patients with renal impairment, doses and/or frequency of administration
should be modified in response to the degree of renal impairment; a high
percentage of patients with infectious mononucleosis have developed rash during
therapy with amoxicillin; a low incidence of cross-allergy with other beta-lactams
and cephalosporins exists
Adverse Reactions
1% to 10%:
Central nervous system: Fever
Dermatologic: Urticaria, rash
Miscellaneous: Allergic reactions (includes serum sickness, rash, angioedema,
bronchospasm, hypotension, etc)
<1%: Seizures, anxiety, confusion, hallucinations, depression (with large doses or
patients with renal dysfunction), nausea, vomiting, leukopenia, neutropenia,
thrombocytopenia, jaundice, interstitial nephritis
Overdosage/Toxicology
Symptoms of penicillin overdose include neuromuscular hypersensitivity
(agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and
electrolyte imbalance with potassium or sodium salts, especially in renal failure
Hemodialysis may be helpful to aid in the removal of the drug from the blood,
otherwise most treatment is supportive or symptom directed
Drug Interactions
Decreased effect: Efficacy of oral contraceptives may be reduced
Increased effect: Disulfiram, probenecid may increase amoxicillin levels

Increased toxicity: Allopurinol theoretically has an additive potential for

amoxicillin rash
Stability
Oral suspension remains stable for 7 days at room temperature or 14 days if
refrigerated; unit dose antibiotic oral syringes are stable for 48 hours
Mechanism of Action
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin
binding proteins (PBPs); which in turn inhibits the final transpeptidation step of
peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall
biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic
enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Pharmacodynamics/Kinetics
Absorption: Oral: Rapid and nearly complete; food does not interfere
Distribution: Widely distributed to most body fluids and bone; penetration into
cells, eyes, and across normal meninges is poor
Protein binding: 17% to 20%
Ratio of CSF to blood: Normal meninges: <1%; Inflamed meninges: 8% to 90%
Metabolism: Partial
Half-life:
Neonates, full-term: 3.7 hours
Infants and Children: 1-2 hours
Adults with normal renal function: 0.7-1.4 hours
Patients with Clcr <10 mL/minute: 7-21 hours
Time to peak: 2 hours (capsule) and 1 hour (suspension)
Elimination: Renal excretion (80% as unchanged drug); lower in neonates
Usual Dosage
Oral:
Subacute bacterial endocarditis prophylaxis: 50 mg/kg 1 hour before procedure
Adults: 250-500 mg every 8 hours or 500-875 mg twice daily; maximum dose: 23 g/day
Endocarditis prophylaxis: 2 g 1 hour before procedure
Helicobacter pylori: 250-500 mg 3 times/day or 500-875 mg twice daily;
clinically effective treatment regimens include triple therapy with amoxicillin or

tetracycline, metronidazole, and bismuth subsalicylate; amoxicillin,

metronidazole, and an H2-receptor antagonist; amoxicillin, lansoprazole, and
clarithromycin.
Dosing interval in renal impairment:
Clcr 10-50 mL/minute: Administer every 12 hours
Clcr <10 mL/minute: Administer every 24 hours
Dialysis: Moderately dialyzable (20% to 50%) by hemo- or peritoneal dialysis;
approximately 50 mg of amoxicillin per liter of filtrate is removed by continuous
arteriovenous or venovenous hemofiltration (CAVH); dose as per Clcr <10
mL/minute guidelines
Dietary Considerations
Food: May be taken with food
Monitoring Parameters
With prolonged therapy, monitor renal, hepatic, and hematologic function
periodically; assess patient at beginning and throughout therapy for infection;
monitor for signs of anaphylaxis during first dose
Test Interactions
May interfere with urinary glucose tests using cupric sulfate (Benedict's solution,
Clinitest); may inactivate aminoglycosides in vitro
Mental Health: Effects on Mental Status
Rarely large doses may produce confusion, hallucinations, and depression;
penicillins have been reported to cause apprehension, illusions, agitation,
insomnia, depersonalization, and encephalopathy
Mental Health: Effects on Psychiatric Treatment
Disulfiram may increase amoxicillin levels
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
No information available to require special precautions
Dental Health: Effects on Dental Treatment
Prolonged use of penicillins may lead to development of oral candidiasis

Patient Information
Take entire prescription, even if you are feeling better. Take at equal intervals
around-the-clock; may be taken with milk, juice, or food. You may experience
nausea or vomiting (small frequent meals, frequent mouth care, sucking lozenges,
or chewing gum may help). If diabetic, drug may cause false tests with Clinitest
urine glucose monitoring; use of glucose oxidase methods (Clinistix) or serum
glucose monitoring is preferable. This drug may interfere with oral contraceptives;
an alternate form of birth control should be used. Report rash; unusual diarrhea;
vaginal itching, burning, or pain; unresolved vomiting or constipation; fever or
chills; unusual bruising or bleeding; or if condition being treated worsens or does
not improve by the time prescription is completed.
Nursing Implications
Assess patient at beginning and throughout therapy for infection; observe for signs
and symptoms of anaphylaxis; obtain specimens for C&S before the first dose;
administer around-the-clock rather than 3 times/day, etc, (ie, 8-4-12, not 9-1-5) to
promote less variation in peak and trough serum levels
With prolonged therapy, monitor renal, hepatic, and hematologic function
periodically
Dosage Forms
Capsule, as trihydrate: 250 mg, 500 mg
Powder for oral suspension, as trihydrate: 125 mg/5 mL (5 mL, 80 mL, 100 mL,
150 mL, 200 mL); 250 mg/5 mL (5 mL, 80 mL, 100 mL, 150 mL, 200 mL)
Powder for oral suspension, drops, as trihydrate: 50 mg/mL (15 mL, 30 mL)
Suspension, oral: 200 mg/5 mL; 400 mg/5 mL
Tablet, chewable, as trihydrate: 125 mg, 200 mg, 250 mg, 400 mg
Tablet, film coated: 500 mg, 875 mg
References
Boguniewicz M and Leung DY, "Hypersensitivity Reactions to Antibiotics
Commonly Used in Children," Pediatr Infect Dis J, 1995, 14(3):221-31.
Canafax, DM, Yuan Z, Chonmaitree T, et al, "Amoxicillin Middle Ear Fluid
Penetration and Pharmacokinetics in Children with Acute Otitis Media," Pediatr
Infect Dis J, 1998, 17(2):149-56.
Dajani AS, Taubert KA, Wilson WW, et al, "Prevention of Bacterial Endocarditis.
Recommendations by the American Heart Association," JAMA 1997,
277(22):1794-801.
Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988,
318(7):419-26 and 318(8):490-500.
Dougall HT, et al, "The Effect of Amoxicillin on Salivary Nitrite Concentrations:
An Important Mechanism of Adverse Reactions?" Br J Clin Pharmacol, 1995,
39(4):460-2.
Hautekeete ML, Brenard R, Horsmans Y, et al, "Liver Injury Related to

Amoxycillin-Clavulanic Acid: Interlobular Bile-Duct Lesions and Extrahepatic

Manifestations," J Hepatol, 1995, 22(1):71-7.
Hill S, Yeates M, Pathy J, et al, "A Controlled Trial of Norfloxacin and
Amoxicillin in the Treatment of Uncomplicated Urinary Tract Infection in the
Elderly," J Antimicrob Chemother, 1985, 15(4):505-6.
Jones KH and Hill SA, "The Toxicology, Absorption and Pharmacokinetics of
Amoxicillin," Adv Clin Pharmacol, 1974, 7:20.
Oe PL, et al, "Pharmacokinetics of the New Penicillins, Amoxicillin and
Flucloxacillin in Patients With Terminal Renal Failure Undergoing Hemodialysis,"
Chemotherapy, 1973, 19:279.
Parry MF, "The Penicillins," Med Clin North Am, 1987, 71(6):1093-112.
Prignet JM, Galzin M, Duval JL, et al, "Amoxicillin-Induced Esophageal Ulcer
With Intractable Hiccups as the Presenting Manifestation," Semaine des Hopitaux,
1995, 71:186-7.
Westphal JF, Jehl F, Brogard JM, et al,"Amoxicillin Intestinal Absorption
Reduction by Amiloride: Possible Role of the Na+-H+ Exchanger," Clin
Pharmacol Ther, 1995, 57(3):257-64.
Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.
Wynn RL, "Amoxicillin Update," Gen Dent, 1991, 39(5):322,4,6.