Class: Aminopenicillins
Chemical Name: [2S - [2α,5α,6β(S*)]] - 6 - [[Amino(4 - hydroxyphenyl)acetyl]amino] - 3,3 - dimethyl - 7 - oxo - 4 - thia - 1 - azabicyclo[3.2.0]heptane - 2 - carboxylic acid trihydrate
CAS Number: 61336-70-7
Brands: Amoxil, Trimox, Prevpac
Introduction
Antibacterial; β-lactam antibiotic; an aminopenicillin.6 62
Uses for Amoxicillin
Otitis Media
Treatment of acute otitis media (AOM).1 140 176 177 190 192 199 200 209 210 211 244 AAP, AAFP, CDC, and others recommend amoxicillin as drug of first choice for initial treatment of AOM,190 200 202 204 205 210 244 unless patient has severe illness (moderate to severe otalgia or fever ≥39°C)244 or the infection is suspected of being caused by β-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis, in which case the fixed combination of amoxicillin and clavulanate is recommended for initial treatment.190 200 202 204 205 210 244 Those who fail to respond to amoxicillin should be retreated with amoxicillin and clavulanate.244
Has been used for prevention of recurrent AOM†.190 206 207 214 217 219 220 222 223 224 225 226 Such prophylaxis not generally recommended103 104 206 217 220 since it is minimally effective and may promote emergence of resistance.103 104 106 190 202 214 217 Use only in selected patients with >3 episodes within 6 months or >4 episodes within 12 months; drugs of choice are amoxicillin or sulfisoxazole.190 193
Has been used for management of otitis media with effusion† (OME).193 206 208 219 221 227 Anti-infectives not usually recommended;111 115 206 208 219 221 245 they provide only limited benefit in enhancing resolution of effusion and may promote resistance.115 207 208 219 AAP, AAFP, and others recommend watchful waiting for 3 months from date of effusion onset or diagnosis in those 2 months to 12 years of age who are not at risk for speech, language, or learning problems; some suggest a short course of anti-infectives may be considered for possible short-term benefits when parent and/or caregiver expresses a strong aversion to impending surgery.245 If anti-infectives are used, amoxicillin or the fixed combination of amoxicillin and clavulanate recommended.219 221 227
Pharyngitis and Tonsillitis
Treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A β-hemolytic streptococci).1 6 35 39 108 109 110 190 240 242
AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice;190 240 241 242 oral cephalosporins and oral macrolides are considered alternatives.190 240 241 242 Amoxicillin sometimes used instead of penicillin V, especially for young children.35 39 108 109 110 190 242
A second episode can be retreated with the same or other treatment of choice;190 242 other regimens (amoxicillin and clavulanate, clindamycin, penicillin G benzathine with or without rifampin) recommended for symptomatic patients with multiple, recurrent episodes.190 240 242
Consider that multiple, recurrent episodes of symptomatic pharyngitis within several months to years may indicate a streptococcal carrier experiencing repeated episodes of nonstreptococcal (e.g., viral) pharyngitis;240 242 treatment not usually recommended for streptococcal pharyngeal carriers.190 240 242
Respiratory Tract Infections
Treatment of lower respiratory tract infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), S. pneumoniae, Staphylococcus, or H. influenzae.1 6 57 62 73 81
Skin and Skin Structure Infections
Treatment of skin and skin structure infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), Staphylococcus, or Escherichia coli.1
Urinary Tract Infections (UTIs)
Treatment of UTIs caused by susceptible Enterococcus faecalis, Escherichia coli, or Proteus mirabilis.1 3 4 6 75 76 78 81 A drug of choice for treatment of uncomplicated UTIs caused by E. faecalis;81 consider high incidence of amoxicillin-resistant E. coli and other Enterobacteriaceae.6
Gonorrhea
Previously used for treatment of acute uncomplicated gonorrhea (anogenital and urethral) caused by susceptible Neisseria gonorrhoeae.1 6 94 184 No longer recommended for gonorrhea by CDC or other experts94 189 190 (high incidence of penicillin-resistant strains).
Typhoid Fever and other Salmonella Infections
Alternative for treatment of typhoid fever† (enteric fever) caused by susceptible Salmonella typhi.6 57 64 66 68 81 190 Drugs of choice are fluoroquinolones and third generation cephalosporins (e.g., ceftriaxone, cefotaxime);81 190 consider that multidrug-resistant strains of S. typhi (strains resistant to ampicillin, amoxicillin, chloramphenicol, and/or co-trimoxazole) reported with increasing frequency.102 190
Treatment of chronic carriers of S. typhi†; drugs of choice are fluoroquinolones (e.g., ciprofloxacin), ampicillin, or amoxicillin (with probenecid).6 62 63 65 67 81
Alternative for treatment of gastroenteritis caused by nontyphoidal Salmonella†.190 Anti-infectives not indicated in otherwise healthy individuals with uncomplicated (noninvasive) gastroenteritis, but recommended if gastroenteritis is severe and in those at increased risk of invasive disease (e.g., <6 months or >50 years of age; hemoglobinopathies, severe atherosclerosis, valvular heart disease, prostheses, uremia, chronic GI disease, severe colitis; immunocompromised because of malignancy, immunosuppressive therapy, HIV infection).81 120 121 190 Drugs of choice are fluoroquinolones, third generation cephalosporins (cefotaxime, ceftriaxone), ampicillin, amoxicillin, co-trimoxazole, or chloramphenicol, depending on in vitro susceptibility.81 120 121 190
Helicobacter pylori Infection and Duodenal Ulcer Disease
Treatment of Helicobacter pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer);1 168 172 173 174 eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence.1 107 116 119 122 168 172 173
Used in a multidrug regimen that includes amoxicillin, clarithromycin, and either lansoprazole or omeprazole (triple therapy).1 81 107 168 169 172 173 174 175 Used with lansoprazole (dual therapy) in those allergic to or intolerant of clarithromycin or when clarithromycin resistance is suspected.1 168 169
Lyme Disease
Treatment of early localized or early disseminated Lyme disease† associated with erythema migrans, in the absence of neurologic involvement or third-degree AV heart block.81 95 190 179 181 182 183 184 185 186 188 190 191 238
IDSA, AAP, and others consider amoxicillin a drug of choice for treatment of early localized or early disseminated Lyme disease when oral therapy is appropriate.81 95 179 181 182 185 186 190 232 238 May be used in those with mild Lyme carditis,95 179 181 182 185 186 232 238 Lyme arthritis (without associated neurologic disease),95 181 185 186 190 232 238 or isolated facial nerve palsy (without other neurologic involvement).95 190 238
Amoxicillin is the preferred oral agent for treatment in pregnant women and children <8 years of age who should not receive doxycycline.88 95 179 190 232 238
Chlamydial Infections
Treatment of uncomplicated urethritis and cervicitis caused by Chlamydia trachomatis in pregnant women†.81 157 94 189 190 CDC and others recommend amoxicillin or a macrolide (azithromycin, erythromycin) as drugs of choice for treatment of urogenital chlamydial infections in these women.94 189 190
Prevention of Bacterial Endocarditis
Prevention of bacterial endocarditis in patients undergoing certain dental, oral, respiratory tract, or esophageal procedures† who have cardiac conditions that put them at high or moderate risk.69 72 96 97 99 100 101 AHA recommends amoxicillin as drug of choice for such prophylaxis.96
Prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal) procedures† who have cardiac conditions that put them at moderate-risk.96
An alternative for follow-up to an initial parenteral regimen for prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal procedures† who have cardiac conditions that put them at high-risk.96
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.96
Prevention of S. pneumoniae Infections in Asplenic Individuals
Prevention of S. pneumoniae infections in children with anatomic or functional asplenia† (e.g., congenital, resulting from sickle cell disease or surgery)190 or children with malignant neoplasms or thalassemia.190
Oral penicillin V usually drug of choice;74 190 some experts recommend amoxicillin.190
Children at increased risk for pneumococcal infections should receive pneumococcal 7-valent conjugate vaccine and pneumococcal 23-valent polysaccharide vaccine.190 243 Long-term anti-infective prophylaxis recommended for children with functional or anatomic asplenia regardless of vaccination status.74 190 243
Anthrax
An alternative for postexposure prophylaxis of anthrax† following exposure to aerosolized Bacillus anthracis spores (inhalational anthrax).190 228 229 231 233 235 236 239 Ciprofloxacin or doxycycline are initial drugs of choice for postexposure prophylaxis following a suspected or confirmed bioterrorism-related anthrax exposure.190 231 235 If penicillin susceptibility is confirmed, consideration can be given to changing prophylaxis to a penicillin in infants and children and in pregnant or lactating women; amoxicillin usually recommended.190 231 233 236 239
An alternative for treatment of inhalational anthrax† when a parenteral regimen is not available (e.g., when there are supply or logistic problems in a mass-casualty setting).231
An alternative for treatment of cutaneous anthrax†.231 If cutaneous anthrax occurs in the context of biologic warfare or bioterrorism, initial drugs of choice are ciprofloxacin or doxycycline.231 If penicillin susceptibility is confirmed, consideration can be given to changing to a penicillin in infants and children or in pregnant or lactating women; amoxicillin usually is recommended.231 239
Amoxicillin Dosage and Administration
Administration
Oral Administration
Administer orally without regard to meals.1 4 10 22 29 38 40
Following reconstitution, the required amount of oral suspension should be placed directly on the child’s tongue for swallowing.1 Alternatively, the required amount of suspension can be added to infant formula, milk, fruit juice, water, ginger ale, or cold drinks and these fluids taken immediately and completely consumed.1
For most infections, continue therapy for at least 48–72 hours after patient becomes asymptomatic or evidence that the infection is eradicated is obtained.1 The drug should be given for at least 10 days for treatment of infections caused by S. pyogenes (group A β-hemolytic streptococci).1
Reconstitution
Reconstitute oral suspension at the time of dispensing.1 Tap bottle to thoroughly loosen powder and then add the amount of water specified on the bottle in 2 portions; agitate vigorously after each addition.1
Agitate suspension well prior to administration of each dose.1
Dosage
Available as the trihydrate;1 dosage expressed in terms of anhydrous amoxicillin.1
Pediatric Patients
Neonates and infants ≤12 weeks (3 months) of age can receive amoxicillin in a dosage up to 30 mg/kg daily given in divided doses every 12 hours.1
Pediatric dosage specified below is for those >3 months of age weighing <40 kg.1
Children weighing ≥40 kg should receive usual adult dosage.1
Otitis Media
Treatment of Acute Otitis Media (AOM)
Oral
80–90 mg/kg daily given in 2 or 3 divided doses† recommended by AAP, AAFP, CDC, and others.190 200 201 205 215 244
Usual duration is 10 days;190 200 201 205 215 optimal duration is uncertain.244 AAP and AAFP recommend 10 days in those <6 years of age and in those with severe disease and state 5–7 days may be appropriate in those ≥6 years of age with mild to moderate AOM.244
Prevention of Recurrent AOM†
Oral
20 mg/kg daily given in 1 or 2 divided doses has been used.214 220
Pharyngitis and Tonsillitis
Oral
45 mg/kg daily in 2 divided doses or 40 mg/kg daily in 3 divided doses for 10 days.1 39 108 109
50 mg/kg once daily35 or 750 mg once daily for 10 days†.110
Follow-up throat cultures after treatment of pharyngitis and tonsillitis not indicated in asymptomatic patients,190 240 242 but recommended 2–7 days after treatment in those who remain symptomatic, develop recurring symptoms, or have a history of rheumatic fever and are at unusually high risk for recurrence.240 242
Ear, Nose, and Throat Infections
Oral
25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections per manufacturer.1
45 mg/kg daily in divided doses every 12 hours or 40 mg/kg in divided doses every 8 hours for severe infections per manufacturer.1
Respiratory Tract Infections
Oral
45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for mild, moderate, or severe lower respiratory tract infections.1
Skin and Skin Structure Infections
Oral
25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections.1
45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for severe infections or those caused by less susceptible bacteria.1
Urinary Tract Infections (UTIs)
Oral
25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections.1
45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for severe infections or those caused by less susceptible bacteria.1
Gonorrhea
Oral
Prepubertal children ≥2 years of age: 50 mg/kg as a single dose given with a single dose of probenecid (25 mg/kg).1
No longer recommended for gonorrhea by the CDC or other experts.94 189
Lyme Disease
Oral
25–50 mg/kg daily (up to 2 g daily) in 2–3 divided doses for 14–21 days for treatment of early localized or early disseminated Lyme disease†.95 179 181 182 185 190 238
50 mg/kg daily in 3 divided doses for 14–28 days for mild Lyme carditis95 179 181 182 185 186 or for 28 days for Lyme arthritis (without associated neurologic disease).95 190 181 185 186 232 238
Prevention of Bacterial Endocarditis
Patients Undergoing Certain Dental, Oral, Respiratory Tract, or Esophageal Procedures
Oral
50 mg/kg given 1 hour prior to the procedure.96
Patients Undergoing Certain GU or GI (except Esophageal) Procedures
Oral
50 mg/kg as a single dose given 1 hour prior to the procedure for moderate-risk patients.96
For high-risk patients, give an initial IM or IV dose of ampicillin with IM or IV gentamicin within 30 minutes of starting the procedure followed by 25 mg/kg of amoxicillin 6 hours later.96
Prevention of S. pneumoniae Infections in Asplenic Individuals†
Oral
20 mg/kg daily in children with anatomic or functional asplenia.190
In infants with sickle cell anemia, initiate prophylaxis as soon as diagnosis is established (preferably by 2 months of age);190 74 continue until approximately 5 years of age.190 74 243 Appropriate duration in children with asplenia from other causes unknown;190 some experts recommend that asplenic children at high risk receive prophylaxis throughout childhood and into adulthood.190
Anthrax
Postexposure Prophylaxis
Oral
80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for 60 days for postexposure prophylaxis following exposure to B. anthracis spores (inhalational anthrax)†.190 231 233 239
500 mg every 8 hours for 60 days in those weighing ≥20 kg.231
Use only if penicillin susceptibility is confirmed.190 228
Inhalational Anthrax
Oral
80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for 60 days for treatment of inhalational anthrax in a mass-casualty setting†.231
500 mg every 8 hours for 60 days for those weighing ≥20 kg.231
Cutaneous Anthrax
Oral
80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for treatment of uncomplicated cutaneous anthrax†.234 231
Treat for 60 days if cutaneous anthrax occurred as the result of exposure to aerosolized anthrax spores;231 234 7–10 days may be adequate if it occurred as the result of natural or endemic exposure to anthrax.231 234
Adults
Pharyngitis and Tonsillitis
Oral
500 mg 3 times daily39 or 750 mg once daily† for 10 days.35 110
Follow-up throat cultures after treatment of pharyngitis and tonsillitis not indicated in asymptomatic patients,190 240 242 but recommended 2–7 days after treatment in those who remain symptomatic, develop recurring symptoms, or have a history of rheumatic fever and are at unusually high risk for recurrence.240 242
Ear, Nose, and Throat Infections
Oral
500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections per manufacturer.1
875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria per manufacturer.1
Respiratory Tract Infections
Oral
875 mg every 12 hours or 500 mg every 8 hours for mild, moderate, or severe lower respiratory tract infections.1
Skin and Skin Structure Infections
Oral
500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections.1
875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria.1
Urinary Tract Infections (UTIs)
Oral
500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections.1
875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria.1
Gonorrhea
Oral
3 g as a single dose.1
No longer recommended for gonorrhea by the CDC or other experts.94 189
Typhoid Fever
Oral
100 mg/kg daily or 1–1.5 g every 6 hours for 14 days.6
Helicobacter pylori Infection and Duodenal Ulcer Disease
Oral
1 g 2 times daily for 10 or 14 days given in conjunction with clarithromycin and either lansoprazole or omeprazole (triple therapy).1 168 172 173 174
1 g 3 times daily for 14 days given in conjunction with lansoprazole (dual therapy).1 168
Lyme Disease
Oral
500 mg 3 times daily for 14–21 days for treatment of early localized or early disseminated Lyme disease†.95 238
500 mg 3 times daily for 14–28 days for mild Lyme carditis95 179 181 182 185 186 or for 28 days for Lyme arthritis (without associated neurologic disease).95 190 181 185 186 232 238
Chlamydial Infections
Oral
500 mg 3 times daily for 7 days for treatment of chlamydial infections in pregnant women†.94 189 190
Repeat testing (preferably by culture) recommended 3 weeks after completion of treatment.94
Prevention of Bacterial Endocarditis
Patients Undergoing Certain Dental, Oral, Respiratory Tract, or Esophageal Procedures
Oral
2 g given 1 hour prior to the procedure.96
Patients Undergoing Certain GU or GI (except Esophageal) Procedures
Oral
2 g given 1 hour prior to the procedure in moderate-risk patients.96
For high-risk patients, give an initial IM or IV dose of ampicillin with IM or IV gentamicin within 30 minutes of starting the procedure followed by 1 g of amoxicillin 6 hours later.96
Anthrax
Postexposure Prophylaxis
Oral
500 mg every 8 hours for 60 days for postexposure prophylaxis following exposure to B. anthracis spores†; use only if penicillin susceptibility confirmed.231 233 236
Inhalational Anthrax
Oral
500 mg every 8 hours for 60 days for treatment of inhalational anthrax†.231
Cutaneous Anthrax
Oral
500 mg every 8 hours for treatment of inhalational anthrax†.231
Treat for 60 days if cutaneous anthrax occurred as the result of exposure to aerosolized anthrax spores;231 234 7–10 days may be adequate if it occurred as the result of natural or endemic exposure to anthrax.231 234
Prescribing Limits
Pediatric Patients
Neonates and Infants ≤12 weeks (3 Months) of Age
Oral
Maximum 30 mg/kg daily in divided doses every 12 hours.1
Prevention of Bacterial Endocarditis
Oral
Dosage should not exceed adult dosage for prevention of bacterial endocarditis.96
Special Populations
Renal Impairment
Dosage adjustment necessary in severe renal impairment.1 6 41 82 83
Do not use 875-mg tablets in those with severe renal impairment and GFR <30 mL/minute.1
Dosage recommendations not available for pediatric patients with renal impairment.1
Dosage for Adults with Renal Impairment
GFR (mL/min)
|
Daily Dosage
|
|---|
10–30
|
250 or 500 mg every 12 hours depending on infection severity1
|
<10
|
250 or 500 mg every 24 hours depending on infection severity1
|
Hemodialysis Patients
|
250 or 500 mg every 24 hours depending on infection severity; with an additional dose both during and at the end of dialysis1
|
Cautions for Amoxicillin
Contraindications
Warnings/Precautions
Warnings
Superinfection/Clostridium difficile-associated Colitis
Possible emergence and overgrowth of nonsusceptible bacteria or fungi.1 21 Discontinue and institute appropriate therapy if superinfection occurs.1
Treatment with anti-infectives may permit overgrowth of clostridia.1 Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-associated pseudomembranous colitis) if diarrhea develops and manage accordingly.1 194 195 196 197 198
Some mild cases of C. difficile-associated diarrhea and colitis may respond to discontinuance alone.1 194 195 196 197 198 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation; appropriate anti-infective therapy (e.g., oral metronidazole or vancomycin) recommended if colitis is severe.1 194 195 196 197 198
Sensitivity Reactions
Hypersensitivity Reactions
Serious and occasionally fatal hypersensitivity reactions, including anaphylaxis, reported with penicillins.1 6 51 53 55
Prior to initiation of therapy, make careful inquiry regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other drugs.1 Partial cross-allergenicity occurs among penicillins and other β-lactam antibiotics including cephalosporins and cephamycins.1 6
If a severe hypersensitivity reaction occurs, discontinue immediately and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1
General Precautions
Selection and Use of Anti-infectives
To reduce development of drug-resistant bacteria and maintain effectiveness of amoxicillin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.1
When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1
Hepatic Effects
Moderate increases in serum AST and/or ALT reported.1
Hepatic dysfunction, including cholestatic jaundice, hepatic cholestasis, and acute cytolytic hepatitis reported.1
Assess hepatic function periodically during prolonged therapy.1
Renal Effects
Assess renal function periodically during prolonged therapy.1
Hematologic Effects
Adverse hematologic effects (e.g., anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, thrombocytopenic purpura) reported with penicillins.1 Usually reversible when drug discontinued; may be a hypersensitivity reaction.1
Assess hematologic function periodically during prolonged therapy.1
Mononucleosis
Possible increased risk of rash in patients with mononucleosis; use in these patients not recommended.4 29 54 60
Phenylketonuria
200- and 400-mg chewable tablets contain aspartame (NutraSweet), which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively.1 3
Oral suspensions do not contain aspartame and can be used in individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine.1
Use of Fixed Combination
When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.
Specific Populations
Pregnancy
Category B.
Recommended as an alternative for various indications in pregnant women (e.g., treatment of chlamydial infections†,94 189 190 treatment of Lyme disease†,88 95 181 182 190 191 postexposure prophylaxis or treatment of anthrax†).231
Lactation
Distributed into milk; use with caution.1 4 6 26 49
Use in a breast-feeding woman may result in sensitization of infants.1
Recommended as an alternative for postexposure prophylaxis or treatment of anthrax† in women who are breast-feeding.239
Pediatric Use
Renal clearance of amoxicillin may be delayed in neonates and young infants because of incompletely developed renal function.20 27 32 62 128
Neonates and infants ≤12 weeks (3 months) of age should receive no more than 30 mg/kg daily given in divided doses every 12 hours.1
Tooth discoloration (brown, yellow, gray) reported rarely, most frequently in pediatric patients.1 Brushing or dental cleaning reduces or eliminates discoloration in most cases.1
Geriatric Use
Renal clearance may be decreased.
Hepatic Impairment
Assess hepatic function periodically during prolonged therapy.1
Renal Impairment
Assess renal function periodically during prolonged therapy.1
Dosage adjustments necessary in severe renal impairment.1 41 82 83
Common Adverse Effects
Adverse GI effects (e.g., nausea, vomiting, diarrhea), hypersensitivity reactions (e.g., rash).1 4 52 142
Interactions for Amoxicillin
Specific Drugs and Laboratory Tests
Drug
|
Interaction
|
Comments
|
|---|
Allopurinol
|
Possible increased incidence of rash;59 61 84 reported with ampicillin but no data regarding amoxicillin59 61 84
|
Unclear whether potentiation of rash is caused by allopurinol or hyperuricemia present in these patients59 61 84
|
Chloramphenicol
|
In vitro evidence of antagonism1
|
Clinical importance unclear1
|
Clavulanic acid
|
In vitro and in vivo synergistic bactericidal effect13 14 15 16 84 85 86 87 127
|
Used to therapeutic advantage in infections caused by β-lactamase-producing bacteria;84 commercially available in fixed combination with clavulanate potassium84
|
Macrolides
|
In vitro evidence of antagonism1
|
Clinic |
