Amoxicillin for gum infection

Whilst we race against time to find a vaccine and COVID-19 treatments in many countries, scientists are sharing information and governments are collaborating with the pharmaceutical industry to provide a not-for-profit solution.

Once again, the focus of these collaborations are on the healthcare solution, rather than the economic impact. In the meantime, many have lost their lives before their time, not only due to the coronavirus itself but also because it opens to the door to opportunistic or secondary bacterial infections which may be fatal if not treated with effective antibiotics. However, drug-resistant infections are cited by the WHO as one of the biggest threats to global health today, estimating 700,000 annual global deaths, rising to 10 million by 2050.

In the post war era, antibiotics have revolutionised the field of medicine. They enabled successful treatments such as chemotherapy for cancer patients and making routine surgery a safer option e.g. The healthcare treatments that we know and have been used to accessing, are often referred to as “ Modern Medicine ”.

Canon David Staples shared his memories of the healthcare system during the war years: “The healthcare system was very different then.

When you had an illness you spent long periods in bed, sweating it out as healthcare was not free and many could not afford access to the medical men who often worked as one man bands from wooden sheds in their back gardens.” Today “Modern Medicine” as we know it is taken for granted.

The current pandemic has shown us how much we rely on our National Health Service, which is free for everyone at point of care.

In the war years, this was not the case as Canon David Staples recalls: “I knew children at school whose parents couldn’t afford a doctor and relied on an unqualified “grandmother” who lived up the street who had convinced everyone (including herself) that she was the font of all knowledge!” In this current crisis, many of the treatments we have become so used to are unavailable due to the high risks to these patients of contracting COVID-19.

May staff have been diverted from their specialist duties to the “ frontline ”. There have been many examples in the news of patient dissatisfaction due to the suspension of “Modern Medicine”, but little thought has been given to the impact of drug-resistant infections caused by antibiotic resistance on the future of “Modern Medicine”.

There is now evidence that 15% of deaths in Wuhan were due to opportunistic or secondary bacterial infections. Antibiotics do not kill viruses but they should be effective against bacterial infections.

Yet, the global public health crisis of drug- resistant infections has not yet been recognised as being worthy of not-for-profit collaborations such as the WWII Penicillin Project or the current coronavirus projects.

Antibiotics and coronavirus research is just as important to continued global health as the penicillin project. Research into new treatments for drug-resistant infections is critical to the future of “Modern Medicine”. Antibiotic Research UK is a respected medical research charity currently funding a significant number of research projects to combat drug-resistant infections. You can read more about our research successes to date here.

So here at Antibiotic Research UK we are working hard to overcome and prevent deaths from drug-resistant infections. Together we

can

Zhou et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

Benzathine penicillin G (BPG) has been in use since the 1950s for treatment of skin infections, bacterial pharyngitis, syphilis and prevention of recurrent episodes of acute rheumatic fever (ARF).

Current guidelines recommend BPG every 4 weeks for a minimum of 10 years to prevent the progression to rheumatic heart disease (RHD). Our program of work has the ultimate aims of improving quality, supply and acceptability of existing formulations of BPG, and of developing a novel long-acting penicillin formulation. Some of the substudies in this program include: Penicillin Levels for Rheumatic Heart Disease - WA Urban Site : This recently completed cohort study involved participants at Princess Margaret Hospital who were prescribed BPG for secondary prophylaxis of RHD. Dry blood spot (DBS) samples & throat swabs were collected from amoxicillin for chest infection each child.

DBS samples were used to measure plasma penicillin levels & group A streptococcal antibody titres immediately prior to BPG administration & at pre-specified time points within each BPG cycle. Throat swabs were also cultured to determine the presence of Strep A infection.

Penicillin Levels for Rheumatic Heart Disease - Darwin Remote Site : This 6-month cohort study was also completed recently involving participants at Danila Dilba Health Service. This study followed the same process and collected the same samples as the urban study above. Pharmacokinetics of

intramuscular

Ability to guide clinicians as to whether benzathine penicillin G should be delivered to an IM or SQ site, or either.

Better understanding whether there is a difference in injection related pain between IM and SQ injections. Determining if a future reformulated long-acting penicillin should be delivered preferentially at an intramuscular or subcutaneous site.

Research shows children's penicillin prescriptions are below recommended doses. Penicillin prescriptions for millions of children over the age of five could be below the recommended doses. A collaborative study conducted by Imperial College London, King's College London and St George’s, University of London found that 40 per cent of 6-12 year olds and 70 per cent of 12-18 year olds are prescribed doses below current national guidelines. If penicillin doses are below those needed to effectively treat bacterial infections they could result in infections that get worse in some children, increase the demand on health services and increase bacterial resistance to treatment.

Published in British

Journal

It reported on the most commonly prescribed penicillin, amoxicillin, and compared actual doses to the doses recommended by the British National Formulary

for

None of the children under the age of one year received BNFC's recommended dose of 62.5 mg per unit.

In fact, the majority of children under the age of one received double this recommended dose (125 mg). In comparison, 96 per cent of children aged 1-5 received the recommended dose for their age group but the picture was different for older children.

40 per cent of 6-12 year olds and 70 per cent of 12-18 year olds were prescribed unit-doses below the BNFC guidelines.

Similar patterns of prescribing were also found for penicillin V and flucloxacillin. The first author of

the

significant

Although the majority of children will still get better, using too low a dose can sometimes result in some children getting more serious infections.For example if the dose of penicillin to treat tonsillitis or a serious ear infection is too low this can reduce the effectiveness of the treatment so these children may get worse and either have to return for another GP appointment or in some cases could require treatment or even admission to hospital." The BNFC guidelines currently recommend dosing oral penicillins in children accordingly to age-bands, weight-bands or weight-based calculations but many UK GPs routinely use only age-bands. In 2013 there was a change to the guidelines specifically for amoxicillin but the researchers suggest this may in fact have worsened the situation because it introduced a wider age-band from 5 to 18 years. This is likely to increase the under dosing for older ages from 12 to 17 years in whom the pre 2013 dose was equivalent to an adult dose of 500mg.

"The guidance needs to be urgently reviewed and recalculated so we move away from an age-based system to a weight-based system," said Dr Saxena. "The ideal situation would be for us to actually weigh children

and

Due to the rising prevalence of childhood obesity, prescriptions could lead to doses prescribed at too low a level to produce a therapeutic effect.

Dr Sonia Saxena is funded by a National Institute for Health Research (NIHR) Career Development Fellowship. Comparison of UK oral penicillin prescribing for children with British National Formulary for Children age-band recommendations: a descriptive analysis.

Article text (excluding photos or graphics) © Imperial College London.

Photos and graphics subject to third party copyright used with permission or © Imperial College London.

Franca Davenport Communications and Public Affairs. Oral semisynthetic aminopenicillin similar to ampicillin; not stable to beta-lactamases of either gram-positive or gram-negative bacteria; more stable to gastric acid than penicillin; more bioavailable than oral ampicillin; commonly used to treat otitis media, bronchitis, sinusitis; also used in combination regimens for H. Amoxicillin/Amoxicillin Trihydrate/Amoxil Oral Tab Chew: 125mg, 250mg Amoxicillin/Amoxicillin

Trihydrate/Amoxil

1 g PO once daily or 500 mg PO twice daily for 10 days. The American Heart Association (AHA) recommends extended-release amoxicillin as an alternative to penicillin V for rheumatic fever prophylaxis.

25 mg/kg/dose (Max: 500 mg/dose) PO twice daily for 10 days is recommended by the Infectious Diseases Society of America (IDSA). Alternatively, 50 mg/kg/dose PO once daily (Max: 1 g/dose) for 10 days is recommended by The American Heart Association (AHA) as an alternative to penicillin V.

For ear/nose/throat infections in general, the FDA-approved dosage is 20 mg/kg/day PO in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses every 12 hours (Max: 500 mg/dose) for mild to moderate infections and 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) for severe infections. 45 mg/kg/day PO in divided doses every 12 hours is the standard dose for children with uncomplicated disease that is mild to moderate in severity who do not attend daycare and who have not been treated with an antimicrobial agent in the previous 4 weeks.

80 to 90 mg/kg/day PO in divided doses every 12 hours (Max: 2 g/dose) is recommended for children in areas with high rates of S.

pneumoniae resistance (more than 10%, including intermediate- and high-level resistance). Children younger than 2 years should be treated with amoxicillin; clavulanic acid, not amoxicillin alone.

500 mg PO every 12 hours or 250 mg PO every 8 hours for mild/moderate infections and 875 mg PO every 12 hours or 500 mg PO every 8 hours for severe infections. 20 mg/kg/day PO in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses every 12 hours (Max: 500 mg/dose) for mild to moderate infections and 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) for severe infections. 30 mg/kg/day PO given in divided doses every 12 hours.

500 mg PO every 12 hours or 250 mg PO every 8 hours for mild/moderate infections and 875 mg PO every 12 hours or 500 mg PO every 8 hours for severe infections. 80 to 90 mg/kg/day PO

divided

Treat all patients younger than 2 years and patients 2 years and older with severe disease for 10 days. For children 2 to 5 years with mild to moderate disease, a 7-day course is acceptable. For children 6 years and older with mild to moderate disease, a 5- to 7-day course is acceptable.[53345] Although the FDA-approved dosage ranges from 20 to 45 mg/kg/day PO depending on the severity of infection (Max: 500 mg/dose for every 8 hour dosing and 875 mg/dose for every 12 hour dosing), these low doses are not clinically recommended for the treatment of otitis media.[43844] [53345] 80 to 90 mg/kg/day PO divided every 12 hours for 10 days was recommended by experts as first-line therapy in previous guidelines; however, this age group is not addressed in the most current guidelines by the American Academy of Pediatrics (AAP).

Although the FDA-approved dosage ranges from 20 to 45 mg/kg/day depending on the severity of infection, these low doses are not clinically recommended for the treatment of otitis media. 30 mg/kg/day PO divided every 12 hours is the general FDA-approved dosing.

Young infants are less capable of responding to infection, and the clinical manifestations of infection can be subtle.

Because of the increased risk for complications of an undiagnosed systemic infection, every young infant presenting with a fever should be carefully evaluated.

500 mg PO every 12 hours or 250 mg PO every 8 hours. 20 mg/kg/day PO given in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses given every 12 hours (Max: 500 mg/dose). 30 mg/kg/day PO given in divided doses every 12 hours.

875 mg PO every 12 hours or 500 mg PO every 8 hours. 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.

875 mg PO every 12 hours or 500 mg PO every 8 hours.

45 mg/kg/day PO in divided doses every 12 hours or 40 mg/kg/day PO in divided doses every 8 hours (Max: 1,750 mg/day).[43844] 30 mg/kg/day PO in divided doses every 12 hours.[43844] 1 g PO every 8 hours for at least 5 days as monotherapy for outpatients without comorbidities or risk factors for MRSA or P. 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