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Symptoms of Amoxicillin overdosage

Crystalluria, interstitial nephritis.

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Monitor
Periodically assess renal, hepatic, and hematopoietic function during prolonged therapy. Patients diagnosed with gonorrhea should have a serologic test for syphilis at the time of treatment and a follow-up serologic test after 3 mo. In the treatment of UTI, frequent bacteriological and clinical appraisals are necessary.

Amoxicillin Pregnancy precautions
Category B .

Amoxicillin Lactation precautions
Excreted in breast milk.

Amoxicillin Children precautions
Moxatag
Safety and efficacy not established in children younger 12 yr of age.

Amoxicillin Elderly precautions
Differences in response between elderly patients (65 yr of age and older) and younger patients have not been identified.

Amoxicillin Hypersensitivity precautions
Serious and occasionally fatal hypersensitivity (eg, anaphylactic) reactions may occur. Use with caution in cephalosporin-sensitive patients because of possible cross-allergenicity.

Amoxicillin Renal Function precautions
Moxatag
Dosage reduction may be necessary. Administration is not recommended in patients with severe renal function impairment (CrCl less than 30 mL/min) or patients on hemodialysis.

Amoxicillin Superinfection precautions
May result in overgrowth of nonsusceptible bacterial or fungal organisms.

Amoxicillin Phenylketonurics precautions
DisperMox tablets for suspension and Amoxil 200 and 400 mg chewable tablets contain phenylalanine.

Amoxicillin Pseudomembranous colitis precautions
Consider possibility in patients with diarrhea.

Amoxicillin Streptococcal infections precautions
Minimum 10 days required for effective treatment.

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Amoxicillin CNS adverse reactions
Headache (1%); agitation; anxiety; behavioral changes; confusion; convulsions; dizziness; hyperactivity; insomnia.

Amoxicillin Dermatologic adverse reactions
Acute generalized exanthematous pustulosis; erythema multiforme; erythematous maculopapular rashes; exfoliative dermatitis; mucocutaneous candidiasis; Stevens-Johnson syndrome; toxic epidermal necrolysis; urticaria.

Amoxicillin GI adverse reactions
Diarrhea (2%); nausea (1%); black, hairy tongue; hemorrhagic pseudomembranous colitis; tooth discoloration; vomiting.

AmoxicillinGenitourinary adverse reactions
Vulvovaginal mycotic infection (2%); crystalluria.

Amoxicillin Hematologic-Lymphatic adverse reactions
Agranulocytosis; anemia; eosinophilia; hemolytic anemia; leukopenia; thrombocytopenia; thrombocytopenic purpura.

Amoxicillin Hepatic adverse reactions
Acute cytolytic hepatitis; cholestatic jaundice; hepatic cholestasis; increased ALT and AST.

Amoxicillin Hypersensitivity adverse reactions
Anaphylaxis; hypersensitivity vasculitis.

Amoxicillin Miscellaneous adverse reactions
Serum sickness–like reactions.

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Chloramphenicol, macrolide antibiotics (eg, erythromycin), sulfonamides
May impair bactericidal effects of amoxicillin.

Contraceptives, oral
May reduce efficacy of oral contraceptives.

Methotrexate
Methotrexate plasma levels may be elevated, increasing the risk of toxicity.

Probenecid
Renal tubular secretion of amoxicillin may be reduced, resulting in increased and prolonged amoxicillin blood levels.

Tetracyclines
May impair bactericidal effects of amoxicillin.

Laboratory Test Interactions
May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets (enzyme-based tests [eg, Clinistix , Tes-Tape ] are recommended); false-positive direct Coombs test result in certain patient groups; false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test (bromphenol blue test, Multistix , is recommended).

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Store 250 and 500 mg capsules and 125 and 250 mg unreconstituted powder at or below 68°F.

Store 200 and 400 mg unreconstituted powder, 200 and 400 mg chewable tablets, and 500 and 875 mg tablets at or below 77°F. Dispense in a tight container. Any unused portion of the reconstituted suspension must be discarded after 14 days. Refrigeration is preferable but not required.

Store ER tablets at 77°F; excursions are permitted between 59° and 86°F.

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Acute Uncomplicated Gonorrhea
Adults
PO 3 g as a single dose.

Prepubertal Children (2 yr of age and older)
PO Amoxicillin 50 mg/kg combined with probenecid 25 mg/kg as a single dose.

Ear, Nose, Throat, Skin and Skin Structure, GU Tract Infections
Adults and Children Weighing at least 40 kg Mild to moderate infections
PO 500 mg every 12 h or 250 mg every 8 h.

Severe infections
PO 875 mg every 12 h or 500 mg every 8 h.

Children (older than 3 mo of age and weighing less than 40 kg) Mild to moderate infections
PO 25 mg/kg/day in divided doses every 12 h or 20 mg/kg/day in divided doses every 8 h.

Severe infections
PO 45 mg/kg/day in divided doses every 12 h or 40 mg/kg/day in divided doses every 8 h.

H. Pylori Eradication
Adults Triple Therapy
PO Amoxicillin 1 g, clarithromycin 500 mg, and lansoprazole 30 mg all given twice daily (every 12 h) for 14 days.

Dual therapy
PO Amoxicillin 1 g and lansoprazole 30 mg each given 3 times daily (every 12 h) for 14 days.

Impaired Renal Function
Adults
PO Glomerular filtration rate (GFR) of 10 to 30 mL/min: Administer 500 or 250 mg every 12 h, depending on the severity of the infection.

GFR less than 10 mL/min
Administer 500 or 250 mg every 24 h, depending on the severity of the infection.

Hemodialysis patients
Administer 500 or 250 mg every 24 h, depending on the severity of the infection, plus an additional dose during and at the end of dialysis.

ER tablet
Not recommended in patients with CrCl less than 30 mL/min.

Lower Respiratory Tract Infections
Adults and Children Weighing at least 40 kg
PO 875 mg every 12 h or 500 mg every 8 h.

Children (older than 3 mo of age and weighing less than 40 kg)
PO 45 mg/kg/day in divided doses every 12 h or 40 mg/kg/day in divided doses every 8 h.

Tonsillitis, Pharyngitis
Adults and Children 12 yr and older
PO ER tablet: 775 mg once daily, within 1 h of finishing a meal, for 10 days.

General Advice

* In neonates and infants 12 wk of age and younger, the recommended maximum dosage is 30 mg/kg/day divided every 12 h.
* After reconstitution, the required amount of suspension should be placed directly on the child’s tongue for swallowing. Alternatively, add required amount of suspension to formula, milk, fruit juice, water, ginger ale, or cold drink.
* Except for gonorrhea, treatment should be continued for a minimum of 48 to 72 h after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained.
* At least 10 days of treatment for any infection caused by S. pyogenes is recommended to prevent acute rheumatic fever.

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Hypersensitivity to penicillins, cephalosporins, or imipenem.

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Treatment of ear, nose, throat, GU, skin and skin structure, lower respiratory tract, and acute uncomplicated gonorrhea infections caused by susceptible strains of specific organisms. In combination with clarithromycin and/or lansoprazole for the eradication of H. pylori .

Moxatag
Treatment of tonsillitis and/or pharyngitis secondary to Streptococcus pyogenes .

Amoxicillin Unlabeled Uses
Treatment of acute otitis media in children.

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Amoxicillin Absorption
Rapidly absorbed. T max is 1 to 2 h; C max is 3.5 mcg/mL (250 mg dose), 5 mcg/mL (500 mg dose), and approximately 13.8 mcg/mL (875 mg dose).

Extended-release
C max is 6.6 mcg/mL; T max is 3.1 h.

Amoxicillin Distribution
Diffuses into most body tissues and fluids; penetration in CNS is poor unless meninges are inflamed. Approximately 20% protein bound.

Amoxicillin Elimination
Half-life is 61.3 min; approximately 60% excreted in the urine within 6 to 8 h as unchanged drug.

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Inhibits bacterial cell wall mucopeptide synthesis.

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