After taking amoxicillin

aeruginosa or as part of combination therapy for HIV-infected outpatients.

Guide treatment duration by clinical stability.[34362] [64669] 90 mg/kg/day PO in divided doses every 8 to 12 hours (Max: 4 g/day) for 5 to 7 days.[34362] [46963] Dividing 90 mg/kg/day into 3 doses/day increases the probability for reaching a clinical and microbiological cure to 90% compared with the same daily dose divided into 2 doses/day (65%) in patients with pneumococcal pneumonia (MIC of 2 mcg/mL). For less resistant pneumococcal strains (MIC of 0.5 mcg/mL), dividing 90 mg/kg/day into 2 doses will likely achieve a clinical and microbiological cure in more than 99% of children.[51856] Consider the addition of a macrolide for patients 5 years and older who do not have clinical, laboratory, or radiologic evidence to distinguish bacterial CAP from atypical CAP. Depending on the causative organism, definitive therapy may range from 45 to 100 mg/kg/day PO in divided doses.[46963] In HIV-infected patients, amoxicillin is recommended as part of combination therapy for outpatients.[34362] 90 mg/kg/day PO in divided doses every 8 to 12 hours (Max: 4 g/day).[46963] Dividing 90 mg/kg/day into 3 doses/day increases the probability for reaching a clinical and microbiological cure to 90% compared with the same daily dose divided into 2 doses/day (65%) in patients with pneumococcal pneumonia (MIC of 2 mcg/mL).

For less resistant pneumococcal strains (MIC of 0.5 mcg/mL), dividing 90 mg/kg/day into 2 doses will likely achieve a clinical and microbiological cure in more than 99% of children.[51856] Consider the

addition

mg/kg/day

The Infectious Diseases Society of America (IDSA) does not recommend amoxicillin for empiric use due to the antimicrobial resistance.

40 mg/kg/day PO in divided doses every 8 hours (Max: 500 mg/dose) or 45 mg/kg/day PO in divided doses every 12 hours (Max: 875 mg/dose).

30 mg/kg/day PO given in divided doses every 12 hours.

The IDSA recommends 500 mg PO 3 times per day for 14—21 days in the absence of neurological symptoms.

A double-blind, randomized trial compared amoxicillin (without probenecid) with azithromycin in patients with erythema migrans.

Those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution by day 20, the end of the study. Significantly more azithromycin recipients relapsed than amoxicillin recipients. The dose of amoxicillin in this study was 500 mg PO 3 times per day for 20 days. The IDSA recommends 50 mg/kg/day PO in divided doses every 8 hours for 14—21 days.

Amoxicillin 250—375 mg PO three times daily with metronidazole (250 mg PO three times daily) for 7—10 days. 2 g PO as a single dose given 30 to 60 minutes before procedure.

Prophylaxis is recommended for at-risk cardiac patients undergoing dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa. Cardiac patients that are considered to be at highest risk include those with prosthetic cardiac valves or prosthetic material used for cardiac valve repair, previous infective endocarditis, select types of congenital heart disease (CHD), and cardiac transplantation with valvulopathy. 50 mg/kg PO as a single dose (Max: 2 g/dose) given 30 to 60 minutes before procedure.

Prophylaxis is recommended for at-risk cardiac patients undergoing dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa.

Cardiac patients that are considered to be at highest risk include those with prosthetic cardiac valves or prosthetic material used for cardiac valve repair, previous infective endocarditis, select types of congenital heart disease (CHD), and cardiac transplantation with valvulopathy. For acute infections, 50—100 mg/kg/day PO in 3 to 4 divided doses for 14 days.

For chronic carriers, 100 mg/kg/day PO in 3 to 4 divided doses plus probenecid (1 g/day PO for adults or 23 mg/kg/day PO for children) for 6 weeks.

1,000 mg PO twice daily in combination with clarithromycin (500 mg PO twice daily) and lansoprazole (30 mg PO twice amoxicillin 2g daily) for 10 to 14 days is recommended.

Clarithromycin-containing regimens are associated with a high eradication rate and less side effects than regimens that include metronidazole. 1,000 mg PO twice daily with clarithromycin (500 mg PO twice daily) and omeprazole (20 mg twice daily) for 10 to 14 days. For patients with an active ulcer, an additional 14 days of omeprazole (20 mg once daily) is recommended for ulcer healing.

According to ACG, any standard dose PPI may be substituted for omeprazole in this regimen.

More effective triple drug regimens are available and recommended.

The original FDA-approved dual regimen consists of amoxicillin 1,000 mg PO and lansoprazole (30 mg PO), each given three times daily for 14 days. Clinical trials showed eradication rates of about 70%, which is substantially lower than that achieved with triple-drug therapy regimens; triple-drug therapy was shown to be more effective than all possible dual therapy combinations.

1,000 mg PO twice daily with metronidazole (500 mg PO twice daily) and omeprazole (20 mg twice daily) for 10 to 14 days. For patients with an active ulcer, an additional 14 days of omeprazole (20 mg once daily) is recommended for ulcer healing.

According to ACG, any standard dose PPI may be substituted for omeprazole in this regimen.

A prospective, open label study evaluated the effectiveness of levofloxacin-based dual (levofloxacin/rabeprazole) and triple (levofloxacin/amoxicillin/rabeprazole) therapy in eradicating H. Patients (n = 160) were randomized into 4 groups (3 dual and 1 triple therapy regimen).

The dual regimens consisted of levofloxacin 500 mg PO once daily with rabeprazole (20 mg PO once daily) for 5, 7, or 10 days.

The triple regimen included

amoxicillin

Triple therapy resulted in a significantly higher eradication rate (more than 90%) than dual therapy at any duration (70% or less). 25 mg/kg/dose PO twice daily (Max: 1 g/dose) with metronidazole (10 mg/kg/dose PO twice daily [Max: 500 mg/dose]) and a proton pump inhibitor (PPI; 1 to 2 mg/kg/day PO divided every 12 hours [Max: 20 mg/dose]) for 1 to 2 weeks. 25 mg/kg/dose PO twice daily (Max: 1 g/dose) with clarithromycin (10 mg/kg/dose PO twice daily [Max: 500 mg/dose]) and a proton pump inhibitor (PPI; 1 to 2 mg/kg/day PO divided every 12 hours [Max: 20 mg/dose]) for 1 to 2 weeks.

25 mg/kg/dose PO twice daily (Max: 1 g/dose) with a proton pump inhibitor (PPI; 1 to 2 mg/kg/day PO divided every 12 hours [Max: 20 mg/dose]) for 5 days, followed-up by a PPI plus clarithromycin (10 mg/kg/dose PO twice daily [Max: 500 mg/dose]) and metronidazole (10 mg/kg/dose PO twice daily [Max: 500 mg/dose]) for 5 days. 1 g PO every 8 hours as an alternative for penicillin-susceptible strains for patients who cannot take first-line agents (i.e., ciprofloxacin, doxycycline) or if first-line agents are unavailable.

Treat for 7 to 10 days for naturally acquired infection. For a bioterrorism-related event, treat for a total duration of 60 days. Following initial treatment for severe anthrax infection, amoxicillin as a single agent may also be used as follow-up treatment. 75 mg/kg/day PO divided every 8 hours (Max: 1 g/dose) as an alternative for penicillin-susceptible strains.

Treat for 7 to 10 days for naturally acquired infection. For a bioterrorism-related event, continue treatment for 60 days. As oral follow-up combination therapy after initial IV therapy for severe anthrax (non-CNS infection), use amoxicillin in combination with a protein synthesis inhibitor (i.e., clindamycin, doxycycline, linezolid).

Continue therapy to complete a treatment course of at least 14 days; additional prophylaxis to complete an antimicrobial course of up to 60 days may be required. 75 mg/kg/day PO divided every 8 hours as an alternative for penicillin-susceptible strains.

Treat for 7 to 10 days for naturally acquired infection. For a bioterrorism-related event, continue treatment for 60 days. As oral follow-up combination therapy after initial IV therapy for severe anthrax (non-CNS infection), use amoxicillin in combination with a protein synthesis inhibitor (i.e., clindamycin, linezolid).

Continue therapy to complete a treatment course of at least 14 days; additional prophylaxis to complete an antimicrobial course of up to 60 days may be required.

50 mg/kg/day PO divided every 12 hours as an alternative for penicillin-susceptible strains.

Treat for 7 to 10 days for naturally acquired infection. For a bioterrorism-related event, continue treatment for 60 days.

As oral follow-up combination therapy after initial IV therapy for severe anthrax (non-CNS infection), use amoxicillin in combination with a protein synthesis inhibitor (i.e., clindamycin, linezolid). Continue therapy to complete a treatment course of at least 14 days; additional prophylaxis to complete an antimicrobial course of up to 60 days may be required. 1 g PO every 8 hours for 60 days after exposure as an alternative for penicillin-susceptible strains for patients who cannot take first-line agents (i.e., fluoroquinolones, doxycycline) or if first-line agents are unavailable. 75 mg/kg/day PO divided every 8 hours (Max: 1 g/dose) for 60 days after exposure for penicillin-susceptible strains. 75 mg/kg/day PO divided every 8 hours for 60 days after exposure for penicillin-susceptible strains.

50 mg/kg/day PO divided every 12 hours for 60 days after exposure for penicillin-susceptible strains. 250 mg PO every 8 hours in combination with oral erythromycin for 5

days

Women with preterm PROM who are candidates for group B streptococcal (GBS) intrapartum prophylaxis should receive GBS prophylaxis to prevent vertical transmission regardless of earlier treatments.[64408] †Indicates off-label use.

1,750 mg/day PO for most labeled indications; however, doses up to 3 g/day PO have been used off-label.

1,750 mg/day PO for most labeled indications; however, doses up to 3 g/day PO have been used off-label.

1,750 mg/day PO is FDA-approved maximum; however, doses up to 4 g/day PO have been used off-label. 45 mg/kg/day PO is FDA-approved maximum; however, doses up to 100 mg/kg/day PO (Max: 4 g/day) have been used off-label. 4 to 11 months: 45 mg/kg/day PO is FDA-approved maximum; however, doses up to 90 mg/kg/day PO have been used off-label. 1 to 3 months: 30 mg/kg/day PO is FDA-approved maximum; however, doses up to 75 mg/kg/day PO amoxicillin acid have been used off-label. 30 mg/kg/day PO is FDA-approved maximum; however, doses up to 75 mg/kg/day PO have been used off-label. No dosage adjustment needed; amoxicillin is not appreciably metabolized in the liver and does not undergo biliary secretion. The following dosing recommendations pertain to adults.

No specific dosage adjustments for pediatric patients with renal impairment are available at this time; however, dosage intervals should be adjusted.

CrCl 10—30 mL/min: 250—500 mg PO every 12 hours, depending on the severity of the infection.

Do

not

CrCl 3 months of age because of incompletely developed renal function.

Safety and effectiveness of Moxatag extended-release tablets has not been established in neonates, infants, or children.

A service of the

National

bacteria

Similar to penicillin, it covers most Streptococcus species and has improved coverage of Listeria monocytogenes and Enterococcus .

It also has coverage over Haemophilus influenzae , some Escherichia coli , Actinomyces , Clostridial species, Salmonella , Shigella , and Corynebacteria .

Amoxicillin is FDA approved for the treatment of genitourinary tract infections, ear, nose, and throat infections, lower respiratory tract infections, Helicobacter pylori infections, pharyngitis, tonsillitis, and skin and skin structure infections. It is recommended as the first-line treatment by the Infectious Disease Society of America (IDSA), for acute bacterial rhinosinusitis and as one of the treatments for community-acquired pneumonia.[1] For this, it is often in combination with a macrolide antibiotic.

The Centers for Disease Control and Prevention (CDC) recommends its use for post-exposure prophylaxis for anthrax inhalation.[2] It also has other off-label uses, such as erysipeloid, Lyme disease (if doxycycline contraindications exist), and infectious endocarditis prophylaxis, as well as prophylaxis in patients with prosthetic joints undergoing dental procedures. It can be effective in periodontitis in combination with metronidazole and is one of the first-line treatments for group A streptococcus pharyngitis. Amoxicillin is in the class of beta-lactam antibiotics. Beta-lactams act by binding to penicillin-binding proteins that inhibit a process called transpeptidation, leading to activation of autolytic enzymes in the bacterial cell wall. This process leads to lysis of the cell wall, and thus, the destruction of the bacterial cell. This type of activity is referred to as bactericidal killing. Amoxicillin administration can also be in combination with a beta-lactamase inhibitor.

Some examples of these are clavulanic acid and sulbactam. These beta-lactamase inhibitors work by binding irreversibly to the catalytic site of an organism’s penicillinase enzyme, which causes resistance to the original beta-lactam ring.

These drugs do not have inherent bactericidal activity; however, when coupled with amoxicillin, they may broaden spectrum amoxicillin to organisms that produce the penicillinase enzyme.[3] Administration. Bactericidal antibiotics, such as amoxicillin, often are most effective in a “time-dependent” manner, rather than a “concentration-dependent” manner. Time-dependent refers to the time that serum concentrations exceed the minimum-inhibitor-concentration for the microorganism.

Therefore, they are often dosed more frequently, rather than the concentration-dependent drugs, which can be dosed, for example, daily.

The more “around-the-clock” dosing provides less variation in peak and trough serum levels.

Amoxicillin is an oral antibiotic; whereas, ampicillin can be given orally, intravenously, or intramuscularly.

Amoxicillin comes in immediate-release or extended-release tablets.

If given in suspension, it may be mixed and administered with formula, milk, water, fruit juice, ginger ale, or other cold drinks. Administration should take place immediately after mixing. Extended-release tablets should not be crushed, and the administration should be within 1 hour after finishing a meal. Amoxicillin is sometimes preferred over penicillin in children because of its taste. It is important to note that it is excreted by in the majority of people by the kidney, and some renal adjustment and extra caution may be necessary for renal insufficiency.

It is reported to be partially dialyzable, and therefore, immediate-release tablets can be an option for dosing after hemodialysis.

There are no guidelines for hepatic dosing or geriatric dosing. It was a pregnancy category B drug under the old FDA classification system, which means there have been no studies demonstrating clear risk. It has also been reported to get excreted in breast milk.

Amoxicillin is well-tolerated, but some common complaints can be gastrointestinal (GI) symptoms, such as nausea, vomiting, and diarrhea. Superinfections, as with fungi or Clostridium difficile colitis, are also important complications. Crystalluria, nephritis, and hemolytic anemia can happen with prolonged administration.

Of note, patients who take amoxicillin may have less diarrhea than those who take ampicillin, which may lead to better absorption in the gut.