Amoxicillin and clavulanate

As with all medicines, there is the possibility of side effects when you take amoxicillin. These can include: Diarrhoea amoxicillin and prednisone for ear infection Nausea or vomiting Headache Stomach ache Mouth or vaginal yeast infections Swollen, black or ‘hairy’ tongue.

If you feel sick or have diarrhoea while taking amoxicillin avoid rich or spicy food and drink plenty of water.

Try taking your medication after you have eaten your food.

Do not take anti-sickness or anti-diarrhoea tablets without consulting your doctor first.

You should get in touch with a doctor immediately if you have any of the following symptoms or any of those listed on the product leaflet: Skin irritation or itching Problems breathing Severe diarrhea Yellowing of the whites of the eyes or skin A rash or hives Swelling of the tongue or lips Bruising or discolouration of the skin Dark urine.

Note that some of these side effects can appear up to 2 months after completing your course of amoxicillin.

Some medication can worsen existing health conditions or diseases so you must tell your doctor about any illness you have before taking amoxicillin. This includes if you have asthma or allergies or a kidney or liver disorder. If you are allergic to penicillin you should not

take

Certain untreated infections can lead to more serious illnesses such as: Secpticemia Tonsilitis Scarlet fever Kidney inflammation. These are only a handful of examples and whilst we don?t want to cause alarm we want to inform you of the importance of treating bacterial infections with an antibiotic such as amoxicillin.

You must not use amoxicillin if you are allergic to amoxicillin or other penicillin antibiotics.

Some other medications may affect your use of amoxicillin so you should tell your doctor if you are taking them. An interaction can occur when one drug affects the way another works. Medicines that can interact with amoxilciilin include: Anticoagulants (blood thinners, including warfarin) Methotrexate (used to treat some cancers, rheumatoid arthritis, severe psoriasis and other serious illnesses) Probenecid and allopurinol (for gout) Contraceptive pills Other antibiotics.

This is not a complete list and it is vital you tell your doctor if you are taking any other medication or have any serious illness at all which may interact with amoxicillin.

Remember to also inform your doctor if you are taking any herbal medicines or vitamin supplements as these can also interact with amoxicillin. Amoxicillin can be used if you are pregnant and while breastfeeding if taken in normal doses. You should talk to your doctor if you are in either of these situations before taking amoxicillin. It does not affect your ability to drive and does not interact with alcohol.

However, drinking alcohol while taking amoxicillin could increase the possibility of side effects. There is a possibility that your contraception may not be effective while you are taking amoxicillin.

For the time you take amoxicillin you should continue to take your contraceptive pills but use another form of contraception as well, such as a condom.

If you have a bacterial infection you should treat it as soon as possible to prevent things getting worse. A short course of clavulanic acid and amoxicillin the antibiotic amoxicillin should clear up a bacterial infection.

No, you amoxicillin clavulanate uses cannot get amoxicillin without a prescription. The effect of metronidazole plus amoxicillin or metronidazole plus penicillin V on periodontal pathogens in an in vitro biofilm model. Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway. Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway. Anne Isine Bolstad, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Arstadveien 19, NO?5009 Bergen, Norway.

Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway. Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway. Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway.

Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Norway. Anne Isine Bolstad, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Arstadveien 19, NO?5009 Bergen, Norway. A combination of metronidazole (MET) and amoxicillin (AMX) is commonly used as adjunct to mechanical therapy of periodontal disease. The use of broad spectrum antibiotics such as AMX may contribute to development of antibiotic resistance.

The aim was to evaluate the in vitro effect of replacing AMX with penicillin V (PV) in combination with MET on a biofilm model.

A biofilm model consisting of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , and Fusobacterium nucleatum was developed. The biofilms were exposed to AMX + MET and PV + MET in two different concentrations.

Bacterial viability in biofilms following antibiotic exposure was assessed by viable counts and by confocal microscopy.

nucleatum were retrieved from biofilms exposed to AMX + MET or PV + MET.

actinomycetemcomitans was 4–5 logs reduced following antibiotic treatment; no statistical significance was achieved between AMX + MET or PV + MET treated biofilms.

Replacement of AMX with PV at the same concentration, in combination with MET, resulted in similar effect on bacterial viability in this in vitro model. The option of using PV + MET instead of AMX + MET deserves further investigation, as this may contribute to reduce the risk of antibiotic resistance development. The loss of supporting tissues of teeth in periodontal disease is determined by the inflammatory response of the host to microorganisms in subgingival plaque.

The depth of the periodontal pocket correlates with major changes in the composition of the subgingival microbial community, as this becomes more diverse and comprises a higher proportion of anaerobe species (Abusleme et al., 2013 ).

Periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans possess a range of virulence factors that allow them to avoid and modulate the immune response of the host and thus persist at periodontal sites (Hajishengallis, Darveau, & Curtis, 2012 ). They might recolonize treated sites and cause recurrence of periodontal disease. Fusobacterium nucleatum facilitates biofilm formation of the periodontopathogens and late colonizers P .

actinomycetemcomitans and supports their growth in biofilm, exhibiting mutualistic relationships with them (Ali Mohammed, Nerland, Al?Haroni, & Bakken, 2013 ; Biyikoglu, Ricker, & Diaz, 2012 ; Periasamy & Kolenbrander, 2009 ).

actinomycetemcomitans regulates protein expression of other species present in the biofilm (Bao, Bostanci, Selevsek, Thurnheer, & Belibasakis, 2015 ).

Mechanical debridement is the gold standard in the treatment of periodontal disease.

However, in certain situations, an antibiotic treatment may be prescribed in order to eliminate or drastically reduce the amount of periodontal pathogens. The combination of amoxicillin (AMX) and metronidazole (MET) was initially adopted for treatment of patients with refractory periodontitis aiming to eliminate A .

actinomycetemcomitans from the periodontal pockets (van Winkelhoff et al., 1989 ). Later studies have advocated the use of systemically administrated AMX + MET adjunctive to scaling and root planing for the treatment of chronic periodontitis, showing not only greater reduction in the levels of periodontal pathogens such as P . actinomycetemcomitans but also improvements in clinical periodontal parameters (Haffajee, Patel, & Socransky, 2008 ; Sgolastra, Gatto, Petrucci, & Monaco, 2012 ; Sgolastra, Petrucci, Gatto, & Monaco, 2012 ; Soares et al., 2014 ).

The combination of MET (targeting the bacterial DNA) with penicillin (targeting the bacterial cell wall) has synergistic effect and it was earlier recommended in order to increase bacterial susceptibility to antibiotic treatment (Baumgartner & Xia, 2003 ) (Khemaleelakul, Baumgartner, & Pruksakorn, 2002 ). The growth of bacteria in biofilm favors the horizontal transfer of genes, including antibiotic resistance genes (Olsen, Tribble, Fiehn, & Wang, 2013 ; Roberts & Kreth, 2014 ). Overuse and misuse of systemic antibiotics have been related to the appearance or development of bacterial resistance in the subgingival flora (van Winkelhoff et al., 2000 ). In 2014, the Swedish health authorities introduced the use of penicillin V (PV) instead of the broad?spectrum AMX in combination with MET as a contribution to reduce the risk of antibiotic resistance.

The decision was based on knowledge of pharmacodynamics and pharmacokinetics of the antibiotics, knowledge of expected pathogens, risk for ecological damages, as well as clinical experiences ( https://lakemedelsverket.se/antibiotikabehandling?tandvard ). Penicillin V has a narrow spectrum with low risk for adverse effects and disruption of the normal microflora.

Risks for development of resistance drug interactions are low.

Phenoxymethylpenicillin is on The World Health Organization's List of Essential Medicines, considered to be the most effective and safe medicines needed in a health system ( https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines#Antibiotics ). The effect of combining MET and penicillin G (PG) on A . actinomycetemcomitans in vitro has been determined previously (Pavicic, van amoxicillin and antibiotics Winkelhoff, & de Graaff, 1992 ).

However, to our knowledge, there is no in vitro study available to date investigating the effect of the MET + PV combination on periodontal pathogens existing in a biofilm. The aim of this study was to assess the in vitro effect of replacing AMX with penicillin V (PV) in combination with MET, on a biofilm model consisting of A . actinomycetemcomitans strain DSMZ 8324 were used in this study.

Bacteria from frozen stock cultures were first grown on fastidious agar medium (FAA; Oxoid, Basingstoke, UK) for 48–72 hr, then transferred in liquid growth medium.

Brain?heart infusion (Difco Laboratories, USA) supplemented with hemin (5 ?g/ml; Sigma?Aldrich, Schnelldorf, Germany) and menadione (1 ?g/ml; Sigma) was the liquid growth medium used in all experiments, referred to as BHI further in the text.