Amoxicillin (Amoxycillin)

(ah -m o x- ih - S I L L - in )
CLASSIFICATION(S): Antibiotic, penicillin PREGNANCY CATEGORY: B Rx: Amoxil, Amoxil Pediatric Drops, DisperMox, Moxatag, Trimox. WRx: Apo-Amoxi, Gen-Amoxicillin, Lin-Amox, Novamoxin, Nu-Amoxi.
SEE ALSO ANTI-INFECTIVE DRUGS AND PENICILLINS.

USES 1. Ear, nose, and throat infections due to Streptococcus species ( and lactamase-negative only), S. pneumoniae, Staphylococcus species, or Haemophilus influenzae. 2. GU infections due to Escherichia coli, Proteus mirabilis, or Enterococcus faecalis. 3. Skin and skin structure infections due to Streptococcus species ( and hemolytic strains only), Staphylococcus species, or E. coli. 4. Lower respiratory tract infections due to Streptococcus species ( and hemolytic strains only), S. pneumoniae, Staphylococcus species, or H. haemophilus. 5. Acute uncomplicated (anogenital and urethral) gonococcal infections due to Neisseria gonorrhoeae in males and females. 6. In combination with amoxicillin/lansoprazole (dual therapy) or amoxicillin/ lansoprazole/clarithromycin (triple therapy) to treat duodenal ulcers due to Helicobacter pylori. Eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence. 7. Postexposure prophylaxis following confirmed or suspected exposure to Bacillus anthracis. 8. Extended-release tablets (Moxatag) to treat tonsillitis and/or pharyngitis secondary to Streptococcus pyogenes in adults and children 12 years of age and older.

ACTION/KINETICS Action Semisynthetic broad-spectrum penicillin closely related to ampicillin. Binds to penicillin-binding proteins (PBP-1 and PBP-3) in the cytoplasmic membranes of bacteria, thus inhibiting cell wall synthesis. Cell division and growth are inhibited. Destroyed by penicillinase, acid stable, and better absorbed than ampicillin. Pharmacokinetics From 50 to 80% of a PO dose is absorbed from the GI tract. Peak serum levels, PO: 411 mcg/mL after 12 hr. 1 t /2: 60 min. Mostly excreted unchanged in urine. ADDITIONAL CONTRAINDICATIONS Use of the 875 mg tablet in clients with a GFR less than 30 mL/min. SPECIAL CONCERNS Safe use during pregnancy has not been established. Effectiveness of oral contraceptives may be decreased. SIDE EFFECTS Most Common Hypersensitivity, N&V, gastritis, stomatitis. See Penicillins for a complete list of potential side effects. HOW SUPPLIED Capsules: 250 mg, 500 mg; Powder for Oral Suspension: 50 mg/mL, 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL (all strengths are after reconstitution); Tablets: 500 mg, 875 mg; Tablets, Chewable: 125 mg, 200 mg, 250 mg, 400 mg; Tablets, ExtendedRelease: 775 mg; Tablets for Oral Suspension: 200 mg, 400 mg, 600 mg. DOSAGE CAPSULES; ORAL SUSPENSION; TABLETS; TABLETS, CHEWABLE Susceptible infections of ear, nose, throat, GU tract, skin and soft tissues. Mild to moderate infections. Adults and children 40 kg or more, usual, mild to moderate infections: 250 mg q 8 hr or 500 mg q 12 hr; severe infections: 500 mg q 8 hr or 875 mg q 12 hr. Children three months and older and less than 40 kg, mild to moderate infections: 20 mg/kg/day in divided doses q 8 hr or 25 mg/kg/day
IV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

AMOXICILLIN NURSING CONSIDERATIONS

ADMINISTRATION/STORAGE 1. Childs dose should not exceed maximum adult dose. 2. Clients with GFR of 1030 mL/min should receive 250 or 500 mg q 12 hr, depending on severity of infection. Those with GFR <10 mL/min should receive 250 or 500 mg q 24 hr, depending on infection severity. Those on hemodialysis should receive 250 or 500 mg q 24 hr, depending on infection severity; should receive an additional dose both during and at end of dialysis. 3. The recommended upper dose of amoxicillin in neonates and infants 12 weeks of age and younger is 30 mg/kg/day divided every 12 hours. 4. Dry powder stable at room temperature for 1830 months; reconstituted suspension stable 1 week at room temperature and 2 weeks at 28C (3646F). 5. Discard any unused portion of the reconstituted suspension after 14 days. Refrigeration is preferable, but not required. ASSESSMENT 1. List reasons for therapy; C&S results. Note onset, symptoms, severity, location, other associated factors. 2. Note previous reactions to penicillins, cephalosporins, or other antibiotics. 3. Obtain/monitor VS, CBC, renal, and LFTs. CLIENT/FAMILY TEACHING 1. Capsules, chewable tablets, and oral suspension may be taken without regard to meals. 2. Take entire prescription; dont stop if feeling better; creates antibiotic resistance. Works best on empty stomach but may be taken with food if GI upset. 3. For school-age child space evenly over 24-hr period; give before school, upon arrival home, and at bedtime. 4. Chewable tablets available for children; may be taken with food. 5. If using tablet for oral suspension (DisperMox), mix 1 tablet in about 10 mL of water. Drink entire mixture, rinse with small amount of water, and drink
W = Available in Canada

in divided doses q 12 hr; severe infections: 40 mg/kg/day in divided doses q 8 hr or 45 mg/kg/day in divided doses q 12 hr. For children, do not exceed the maximum adult dose. Infections of the lower respiratory tract. Adults and children 40 kg and over, mild/moderate/severe infections: 500 mg q 8 hr or 875 mg q 12 hr. Children 3 months and older and under 40 kg, mild/moderate/severe infections: 40 mg/kg/day in divided doses q 8 hr or 45 mg/kg/day in divided doses q 12 hr. Gonococcal infections, uncomplicated urethral, endocervical, or rectal infections in males and females. Adults: 3 grams as a single PO dose. Children, over 2 years (prepubertal): 50 mg/kg amoxicillin combined with 25 mg/kg probenecid as a single dose. Eradicate H. pylori infections to reduce risk of duodenal ulcer recurrence. The following regimens may be used. (1) Dual Therapy (amoxicillin/lansoprazole), adults: Amoxicillin, 1,000 mg and lansoprazole, 30 mg, each given 3 times per day (q 8 hr) for 14 days. (2) Triple Therapy (amoxicillin/clarithromycin/lansoprazole), adults: Amoxicillin, 1,000 mg, clarithromycin, 500 mg, and lansoprazole, 30 mg, each given 2 times per day (q 12 hr) for 14 days. Anthrax (postexposure prophylaxis following confirmed or suspected exposure to Bacillus anthracis). Adults: 500 PO 3 times per day. Children, less than 9 years of age: 80 mg/kg/day PO divided into 23 doses. Continue prophylaxis until exposure has been excluded. If exposure is confirmed and vaccine is available, continue prophylaxis for 4 weeks and until 3 doses of vaccine have been given or for 3060 days if vaccine is unavailable. TABLETS, EXTENDED-RELEASE Tonsillitis and/or pharyngitis secondary to S. pyogenes. Adults and children 12 years and older: 775 mg (1 extended-release tablet) daily for 10 days taken within 1 hr of finishing a meal. Ensure completion of the 10-day course of therapy.
Bold Italic = life threatening side effect

= black box warning

AMOXICILLIN
contents to ensure entire dose is taken. Do not chew or swallow tablets. 6. Place pediatric drops directly on childs tongue to swallow. May add drops to formula, milk, fruit juice, water, ginger ale, or cold drinks; must take immediately and consume completely. 7. Report any difficulty breathing, increased bruising/bleeding, sore throat,

rash, diarrhea, worsening of symptoms, or lack of response. OUTCOMES/EVALUATE Resolution of infection; symptomatic improvement Therapeutic peak serum drug levels (411 mcg/mL)

C = see color insert

H = Herbal

IV = Intravenous

E = sound alike drug