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Amoxicillin

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Amoxicillin, Amoxil

  • See Also
  1. Aminopenicillin
  2. Ampicillin
  3. Augmentin
  4. Unasyn
  • Indications
  1. Otitis Media
  2. Acute Bacterial Sinusitis
  3. Pneumonia
  4. Group A Streptococcal Pharyngitis
  5. Helicobacter Pylori
  6. Endocarditis Prophylaxis
  • Contraindications
  1. Penicillin Allergy
    1. Cefadroxil and Cefprozil have similar side chains and risk of cross reactivity with Amoxicillin
  • Mechanism
  1. See Aminopenicillin
  • Medications
  1. Amoxicillin Capsules (250 and 500 mg)
  2. Amoxicillin Tablets (500 and 875 mg)
  3. Amoxicillin Chewable Tablets (125, 200, 250 and 400 mg)
  4. Amoxicillin Suspension (125 mg/5ml and 250 mg/5ml)
    1. Stable in the refrigerator for up to 14 days
  • Dosing
  1. Adult
    1. Typical Dosing (e.g. head and neck infections): 875 to 1000 mg orally twice daily
    2. Maximum dose: 3-4 grams/day
  2. Child
    1. Low dose (e.g. Pneumonia): 45 mg/kg/day divided twice daily
    2. High dose (e.g. Otitis Media): 90 mg/kg/day divided twice daily
  3. Renal Dosing (adult dosing adjustments)
    1. eGFR 10 to 30 ml/min: 250 to 500 mg orally twice daily
    2. eGFR <10 ml/min: 250 to 500 mg orally daily (after Hemodialysis)
  • Adverse Effects
  1. See Aminopenicillin
  2. See Penicillin
  3. Maculopapular rash
    1. Onset 5-7 days after initiating medication
    2. Typically not IgE mediated (non-allergic)
      1. No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
    3. Typically safe to use Amoxicillin in future if non-allergic rash alone
      1. Consider IgE Skin Testing if unclear rash etiology
    4. References
      1. Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
  4. Diarrhea
    1. More common with Augmentin
    2. Modifications can decrease stools
      1. Dose exactly by kilogram for children
      2. Avoid food before dose
      3. Consider eating yogurt with each dose
  • Safety
  1. Pregnancy Category B
  2. Safe in Lactation
  • Resources
  1. Amoxicillin Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=843f6053-63d9-47d2-81f1-b6aa78a7c20c
  • References
  1. (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
  4. Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]