Amoxil 500 mg

Immunoglobulin G4 level was 24 mg/dL (reference range: 1–100 mg/dL) which ruled out autoimmune pancreatitis.

The evidence found to implicate a certain drug to the development of acute pancreatitis is often inadequate especially when the mechanism is unknown. proposed a classification system of drug-induced acute pancreatitis. This system was based on the number of case reports found in the literature, the available rechallenge data, latency period and ability to exclude other causes of acute pancreatitis [6].

After reviewing summary of drug induced acute pancreatitis based on drug class, we found that ampicillin and penicillin are considered class IV (single case report published, but neither a rechallenge nor a consistent latency period documented) [6].

If the pancreatitis resolves after discontinuation of the drug, suspicion for drug-induced pancreatitis increases. A firm diagnosis can be reasonably established with a rechallenge of the offending drug that results in the recurrence of pancreatitis symptoms [1,2,3,4].

Very few cases, less than 5 total cases, were documented in the literature regarding ampicillin, penicillin, and amoxicillin/clavulanic acid induced acute pancreatitis with true mechanism still being unidentified [7,8,9,10,11]. Table 2 shows the comparison between our patient’s case with published data in the literature. Drug-induced acute pancreatitis remains rare but should not be disregarded when medical practitioners are faced with a patient presenting with acute pancreatitis with no obvious cause.

Being familiar with reports of drugs causing acute pancreatitis can be helpful in identifying the causality and association with a certain drug.

Despite the fact that DIP can have a benign course with good prognosis, fatal outcomes still occur and thus DIP should not be overlooked.

This case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded.

We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.

We also stress on the importance of encouraging scientists and researchers to better understand the mechanism of developing drug-induced acute pancreatitis.

Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps.

Contributed equally to this work with: Guillaume Binson, Claire Grignon. Roles Investigation, Methodology, Writing – original draft.

Affiliations Department of Pharmacy, University Hospital of Poitiers, Poitiers, France, CIC Inserm, Poitiers, France.

Contributed equally to this work with: Guillaume Binson, Claire Grignon.

Roles Investigation, Methodology, Writing – original draft.

Affiliation Department of Pharmacy, University Hospital of Poitiers, Poitiers, France. Roles Conceptualization, Writing – review & editing.

Affiliation Department of Infectious Diseases, University Hospital of Poitiers, Poitiers, France.

Affiliation Department of Pharmacy, University Hospital of Poitiers, Poitiers, France.

Affiliation

Department

Affiliations CIC Inserm, Poitiers, France, Department of Pharmacokinetics, University Hospital of Poitiers, Poitiers, France. Roles Conceptualization, Methodology, Project administration, Supervision, Writing – review & editing.

Affiliations Department of Pharmacy, University Hospital of Poitiers, Poitiers, France, CIC Inserm, Poitiers, France. Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps. Guillaume Binson, Claire Grignon, Gwenael Le Moal, Pauline Lazaro, Jeremy Lelong, France Roblot, Nicolas Venisse, Antoine Dupuis. Published: August 16, 2019 https://doi.org/10.1371/journal.pone.0221391.

Article Authors Metrics Comments Media Coverage Peer Review. While treatment of serious infectious diseases may require high-dose amoxicillin, continuous infusion may be limited by lack of knowledge regarding the chemical stability of the drug.

Therefore, we have performed a comprehensive study so as to determine the chemical stability of high-dose amoxicillin solutions conducive to safe and effective continuous intravenous administration using portable elastomeric pumps.

First, amoxicillin solubility in water was assessed within the range of 25 to 300 mg/mL. Then, amoxicillin solutions were prepared at different concentrations (25, 50, 125, 250 mg/mL) and stored in different conditions (5±2°C, 25±1°C, 30±1°C and 37±1°C) to investigate the influence of concentration and temperature on the chemical stability of amoxicillin. Finally, its stability was assessed under optimized conditions using a fully validated HPLC-UV stability-indicating method. Degradation products of amoxicillin were investigated by accurate mass determination using high-resolution mass spectrometry. Amoxicillin displayed limited water solubility requiring reconstitution at concentrations below or equal to 150 mg/mL.

Amoxicillin degradation were time, temperature as well as concentration-dependent, resulting in short-term stability, in particular at high concentrations.

Four degradation products of amoxicillin have been identified.

Among them, amoxicilloic acid and diketopiperazine amoxicillin are at risk of allergic reaction and may accumulate in the patient.

Optimized conditions allowing for continuous infusion of high-dose amoxicillin has been determined: amoxicillin should be reconstituted at 25 mg/mL and stored up to 12 hours at room temperature (22 ± 4°C) or up to 24 hours between 4 and 8°C. Citation: Binson G, Grignon C, Le Moal G, Lazaro P, Lelong J, Roblot F, et al.

(2019) Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps.

Editor: Jose das Neves, University of Porto, PORTUGAL. Received: June 19, 2019; Accepted: August 7, 2019; Published: August 16, 2019. This is an open amoxicillin 500 tablet access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

The management of several serious infectious diseases such as bone and joint infections as well as infective endocarditis, requires intravenous administration of high-dose amoxicillin (100–300 mg/kg/day) amoxil over the counter over a prolonged period, ranging from a few weeks to several months [1–4]. ?-Lactams are time-dependent antibiotics, meaning that their efficacy depends on the time that free serum concentrations remain above the minimal inhibitory concentration (MIC) during the dosing interval [5].